North Carolina medical journal [serial]

C&e Hiorarp

Of tJ)f

Dit)t0ion of l£>ealt& affairs
CJntoersitp of Ji3ottfj Carolina

This Book Must Not Be Taken
from the Division of Health

Affairs Buildings.

FOUR DAYSc

This JOURNAL may be kept ouUTWO DAYS,
and is subject to a fine of FIVE fc&IVr*S*day
thereafter. It is DUE on the DAY indicated
below:

NORTH CAROLINA MEDICAL JOURNAL

Owned and Published by

THE MEDICAL SOCIETY OF THE STATE OF NORTH CAROLINA

Under the Direction of Its

EDITORIAL BOARD

Wingate M. Johnson, M.D.

Winston-Salem, Editor

Mr. James T. Barnes

Raleigh, Business Manager

G. Westbrook Murphy, M.D.

Asheville, Chairman

Ernest W. Furgurson, M.D.

Plymouth

John Borden Graham, M.D.

Chapel Hill

William M. Nicholson, M.D.

Durham

Robert W. Prichard, M.D.

Winston-Salem

Charles W. Styron, M.D.

Raleigh

Miss Louise MacMillan

Winston-Salem, Assistant Editor

VOLUME 21

JANUARY-DECEMBER, 1960

300 South Hawthorne Road

EDITORIAL OFFICE

Winston-Salem 7, N. C.

Press of

CARMICHAEL PRINTING COMPANY

1309 Hawthorne Road, SW

Winston-Salem, N. C.

-T

Digitized by the Internet Archive

in 2011 with funding from

North Carolina History of Health Digital Collection, an LSTA-funded NC ECHO digitization grant project

http://www.archive.org/details/ncarolinamed2121960medi

NORTH CAROLINA

IN THIS ISSUE:

THE PRESIDENT'S INAUGURAL ADDRESS
— AMOS N. JOHNSON, M.D. —

N£ 3

Surfadil

thycaine and thenylpyramir.e, Lilly)

SHIELDS

SENSITIVE

SKIN

Each 100 cc. of Lotion Surfadil provide:

local
antihistamine . . Histadyl* ... 2 Gm.

topical anesthetic . Surfacaine* . . 0.5 Gm.

adsorptive and

protective cover Titanium Dioxide . 5 Gm.

The Surfadil coating also acts as a translucent
"shield" to deflect the sun's rays.

Available in spillproof. unbreakable plastic
containers of 75 cc. and in pint bottles.

Hisladyl® (thenylpyramine. Lilly)
Surfacatne® (cyclomethycaine, Lilly)

ELI LILLY AND COMPANY • INDIANAPOLIS 6, INDIANA, U. S. A.

STm,

Table of Contents, Page II

CLINICAL REMISSION

IN A "PROBLEM" ARTHRITIC

In "escaping" rheumatoid arthritis. After gradually "escaping" the ther-
apeutic effects of other steroids, a 52-year-old accountant with ar-
thritis for five years was started on Decadron. 1 mg. /day. Ten months
later, still on the same dosage of Decadron, weight remains constant,
she has lost no time from work, and has had no untoward effects. She
is in clinical remission.*

New convenient b. i. d. alternate dosage schedule: the degree and extent of relief provided by
DECADRON allows for b.i.d. maintenance dosage in many patients with so-called "chronic" condi-
tions. Acute manifestations should first be brought under control with a t.i.d. or q.i.d. schedule.

Supplied: As 0.75 mg. and 0.5 mg. scored, pentagon-shaped tablets in bottles of 100. Also available
as Injection DECADRON Phosphate. Additional information on DECADRON is available to physicians
on request. DECADRON is a trademark of Merck & Co.. inc.

'From a clinical investigator's report to Merck Sharp & Dohme.

Decadron

Dexamethasone

TREATS MORE PATIENTS MORE EFFECTIVELY

&3m MERCK SHARP & DOHME • Division of Merck & Co., Inc., West Point, Pa.

■ ,.

•f.*

/

.T=

SK-

A\

l n

f$ii£

July, 1960

ADVERTISEMENTS

A Sanitarium for Rest Under Medical Supervision, and Treatment of Nervous
and Mental Diseases, Alcoholism and Drug Addiction.

The Pinebluff Sanitarium is situated in the sandhills of North Carolina in a 60-acre park
of long pines. It is located on U. S. Route 1, six miles south of Pinehurst and Southern
Pines. This section is unexcelled for its healthful climate.

Ample facilities are afforded for recreational and occupational therapy, particularly out-
of-doors.

Special stress is laid on psychotherapy. An effort is made to help the patient arrive at
an understanding of his problems and by adjustment to his personality difficulties or
modification of personality traits to effect a cure or improvement in the disease. Two resident
physicians and a limited number of patients afford individual treatment in each case.

For further information write:

The Pineblu££ Sanitarium, Pinebluff, N. c.

Malcolm D. Kemp, M.D.

Medical Director

WELCH ALLYN RECTAL SETS

Welch Allyn distally illuminated proctoscopes
and sigmoidoscopes are designed to meet every
requirement for thorough rectal examination
and treatment. Abundant illumination is pro-
vided directly at the area under observation and
an unobstructed view for diagnosis is assured
through the use of a small, powerful Welch
Allyn "Bright Light" lamp. The outer tube is
calibrated in centimeters and the inner tube is
optically designed to reduce the annoying glare
usually found in this type instrument. The
obturator tip is tapered and curved in an an-
atomically correct manner to facilitate the
passage of the instrument through the sphincter
muscle and by the prostate gland region. Ideally
designed for use with No. 343 biopsy punch.

No. 314 No. 300 proctoscope and No. 308 sigmoidoscope with inflating bulb and No. 725 cord,
in case as illustrated $73.50

No. 343 BIOPSY PUNCH not illustrated S66.00

WINCHESTER

"CAROLINAS' HOUSE OF SERVICE"

WINCHESTER SURGIICAL SUPPLY CO.
119 East 7th Street Charlotte, N. C.

WINCHESTER-RITCH SURGICAL CO.

421 West Smith St. Greensboro, N. C.

II

NORTH CAROLINA MEDICAL JOURNAL

July, 1960

North Carolina Medical Journal

Official Organ of
The Medical Society of the State of North Carolina

Volume 21
Number 7

JULY, 1960

76 CENTS A COPY
$5.00 A YEAR

CONTENT

Original Articles

President's Inaugural
Johnson, M.D. . .

Address — Amos N.

261

Bad Politics and Good Medicine Don't Mix-
Louis M Orr, M.D

264

Three Great Challenges — Leonard W. Larson,
M.D 267

Generalized Salivary Gland Virus Disease in
Postneonatal Life — Charles F. Gilbert,
M.D 270

Antibiotic Resistant Pulmonary Staphylococ-
cic Infections— George L. Calvy, MC, USN 275

Some Facts About Nursing in North Carolina
—Vivian M. Culver 279

A Rural Home Care Program — C. David Gar-
vin, M.D., M.P.H 282

Report on Actions of the House of Delegates,
American Medical Association, One Hun-
dredth Ninth Annual Meeting — F. J. L.
Blasingham, M.D 285

CORRESPONDENCE

Biennial Registration Act — J. R. Gamble, Jr.,
M.D

COMMITTEES AND ORGANIZATIONS

Schedule of Committee and Commission Ap-
pointments, 1960-1961

292

293

Bulletin Board

Coming Meetings

News Notes from the Duke University Med-
ical Center

News Notes from the University of North
Carolina School of Medicine

News Notes from the Bowman Gray School
of Medicine of Wake Forest College . . .

County Societies

News Notes

Announcements

The Month in Washington

308

300
301
302

303
304
304

305

Editorials

The A.M.A.'s One Hundred Ninth Annual

Meeting 289

The Old Order Changeth 289

"Symptomatic Medicine" 290

Nurses and Nursing 291

Medical Prepayment and Our Social Philo-
sophy 291

Book Reviews

309

In Memoriam

312

Classified Advertisements

308

Index to Advertisers
lxiii

Entered as second-class matter January 2. 1940, at the Post Office at Winston-Salem. North Carolina, under the Act of
August 24, 1912. Copyright 1960 by the Medical Society of the State of North Carolina.

17

-202

tL'cka-l Letter SpinTEi^IT
« Shown Below

rolin

idics"

>F CHLORAL HYDRATE

"kry will di«.
"dtbi, column

T,'\ -Dec,

I960

11

WoodeD

4838

able chloral hydrate syrup

containing 10 grains in each teaspoonful.

JONES and VAUGHAN
Richmond 26, Virginia

■

■ ■■■*'■

A most appetizing help for
patients where a cholesterol
depressant diet is prescribed

Wesson's Chicken Cook Book

FREE in quantities

for your distribution to patients

Wesson

..

for Frying
^kirtg and Sala*

Iftfe

UTm]

The enticing variety of dishes offered in "101 Glorious Ways to
Cook Chicken" can help make a restricted regimen less monotonous
and encourages the patient's compliance with it.

The high poly-unsaturated fat content of poultry— prepared in
poly-unsaturated Wesson — makes it a special help to those on
cholesterol depressant diets. Happily, too, chicken is moderate in
calories, universally popular and one of the most economical
protein foods in the grocery today.

Recipes for Chicken Rosemary, Sesame, Jambalaya, Pilaf, etc.,
teach scores of new ways to enhance chicken with herbs and
spices, new combinations with fruits and vegetables, how to use
sauces and seasonings wisely and well. Careful consideration has
been given to the choice of ingredients to keep saturated fats
to a minimum.

Where a vegetable (salad) oil is medically

recommended for a cholesterol depressant regimen,
Wesson is unsurpassed by any readily available brand.

1^% jf&

HICKEN SESAME — with its crunchy nutlike flavor from the Indies — is typical of the glorious eating contained in this new Wesson cook book.

WESSON'S IMPORTANT CONSTITUENTS

Wesson is 100% cottonseed oil . . .
winterized and of selected quality

inoleic acid glycendes (poly-unsaturated) 50-55 %

Jleic acid glycerides (mono-unsaturated) 16-20%

otal unsaturated 70-75%

'almitic, stearic and myristic glycerides (saturated) 25-30%

'hytosterol (predominantly beta sitosterol) 0.3-0.5%

Total tocopherols 0.09-0.12%

Never hydrogenated— completely salt free

Each pint of Wesson contains 437-524 Int. Units of Vitamin E

Send coupon for quantity needed for your patients.

The Wesson People, 210 Baronne Street,
New Orleans 12, La.

Please send me . . . free copies of the Wesson cook book
"101 Glorious Ways to Cook Chicken."

Name. .
Address
City....

.Zone.

.State.

VI NORTH CAROLINA MEDICAL JOURNAL July. 1960

Proven

in over five years of clinical use and
more than 750 published clinical studies

Effective

for relief of anxiety and tension

Outstandingly Safe

• simple dosage schedule produces rapid, reliable
tranquilization without unpredictable excitation

• no cumulative effects, thus no need for difficult
dosage readjustments

• does not produce ataxia, change in appetite or libido

• does not produce depression, Parkinson-like symptoms,
jaundice or agranulocytosis

• does not impair mental efficiency or normal behavior

for
the

tense
and
nervous
patient

Despite the introduction in recent years of "new and dif-
ferent" tranquilizers, Miltown continues, quietly and
steadfastly, to gain in acceptance. Generically and under
the various brand names by which it is distributed,
meprobamate ( Miltown I is prescribed by the medical
profession more than any other tranquilizer in the world.

The reasons are not hard to find. Miltown is a known drug,
evaluated in more than 750 published clinical reports. Its
few side effects have been fully reported; there are no
surprises in store for either the patient or the physician.
It can be relied upon to calm anxiety and tension quickly
and predictably.

Usual dosage : One or two
400 mg. tablets t.i.d.
Supplied: 400 mg. scored tablets,
200 mg. sugar-coated tablets;
or as meprotabs*-400 mg.
unmarked, coated tablets.

Miltown

meprobamate (Wallace)

' WALLACE LABORATORIES / New Brunsivick, N. J.
V*"

July, 1960 ADVERTISEMENTS VII

when that early Monday morning telephone
call is from a weekend do-it-yourselfer

". . . and this morning, Doctor, my back
is so stiff and sore I can hardly move."

now. . . there is a way to prompt, dependable
relief of back distress

the pain goes while the muscle relaxes

POTENT —rapid relief in acute conditions
SAFE — for prolonged use in chronic conditions

notable safety — extremely low toxicity; no known
contraindications; side effects are rare;
drowsiness may occur, usually at higher dosages

rapid action, sustained effect —starts to act
quickly, relief lasts up to 6 hours

easy to use — usual adult dosage is one 350 mg.
tablet 3 times daily and at bedtime

supplied -as 350 mg., white, coated tablets,
bottles of 50; also available for pediatric use:
250 mg., orange capsules, bottles of 50

VAy WALLACE LABORATORIES, New Brunswick, New Jersey

(CARISOPRODOL WALLACE)

VIII NORTH CAROLINA MEDICAL JOURNAL July, 1960

Medical Society of the State of North Carolina

OFFICERS — 1960

President — Amos Neill Johnson, M.D., Garland

President Elect — Claude B. Squires, M.D., 225 Hawthorne Lane, Charlotte
Past. President — John C. Reece, M.D., Grace Hospital, Morganton
First Vice-President — Theodore S. Raiford, M.D., Doctors Building, Asheville
Second Vice-President — Charles T. Wilkinson, M.D., Wake Forest
Secretary — John S. Rhodes, M.D., 700 West Morgan Street, Raleigh
Executive Director — Mr. James T. Barnes, 203 Capital Club Building, Raleigh
The President, Secretary and Executive Director are members ex-officio

of all committees
Speaker-House of Delegates — Donald B. Koonce, M.D., 408 N. 11th St., Wilmington
Vice-Speaker-House of Delegates — E. W. Schoenheit, M.D., 46 Haywood St., Asheville

COUNCILORS — 1958 - 1961

First District— T. P. Brinn, M.D., 118 W. Market Street, Hertford

Vice Councilor — Q. E. Cooke, M.D., Murfreesboro
Second District — Lynwood E. Williams, M.D., Kinston Clinic, Kinston

Vice Councilor — Ernest W. Larkin, Jr., M.D., 211 N. Market St., Washington
Third District — Dewey H. Bridger, M.D., Bladenboro

Vice Councilor — William A. Greene, M.D., 104 E. Commerce St., Whiteville
Fourth District — Edgar T. Beddingfield, Jr., M.D., P.O. Box 137, Stantonsburg

Vice Councilor — Donnie H. Jones, M.D., Box 67, Princeton
Fifth District — Ralph B. Garrison, M.D., 222 N. Main Street, Hamlet

Vice Councilor — Harold A. Peck, M.D., Moore County Hospital, Pinehurst
Sixth District — George W. Paschal, Jr., M.D., 1110 Wake Forest Rd., Raleigh

Vice Councilor— Rives W. Taylor, M.D., P.O. Box 1191, Oxford

Seventh District —

Vice Councilor — Edward S. Bivens, M.D., Stanly County Hospital, Albemarle

Eighth District — Merle D. Bonner, M.D., 1023 N. Elm Street, Greensboro

Vice Councilor — Harry L. Johnson, M.D., P.O. Box 530, Elkin
Ninth District — Thomas Lynch Murphy, M.D., 116 Rutherford St., Salisbury

Vice Councilor — Paul McNeely Deaton, M.D., 766 Hartness St., Statesville
Tenth District — William A. Sams, M.D., Main Street, Marshall

Vice Councilor — W. Otis Duck, M.D., Drawer 517, Mars Hill

DELEGATES TO THE AMERICAN MEDICAL ASSOCIATION

Elias S. Faison, M.D., 1012 Kings Drive, Charlotte

C. F. Strosnider, M.D., 111 E. Chestnut Street, Goldsboro

Millard D. Hill, M.D., 15 W. Hargett Street, Raleigh

William F. Hollister, M.D., (Alternate), Pinehurst Surgical Clinic, Pinehurst

Joseph F. McGowan, M.D., (Alternate), 29 Market Street, Asheville p

Wm. McN. Nicholson, M.D., (Alternate), Duke Hospital, Durham

m

SECTION CHAIRMEN 1959-1960 cl

General Practice of Medicine — Julius Sader, M.D., 205 East Main Street, Brevard
Internal Medicine — Walter Spaeth, M.D., 116 South Road, Elizabeth City
Ophthalmology and Otolaryngology — Charles W. Tillett, Jr., M.D., 1511 Scott

Avenue, Charlotte
Surgery — JAMES E. DAVIS. M.D., 1200 Broad Street, Durham
Pediatrics — William W. Farley, M.D., 903 West Peace Street, Raleigh
Obstetrics & Gynecology — H. Fleming Fuller, M.D., Kinston Clinic, Kinston
Public Health and Education — ISA C. Grant, M.D., Box 949, Raleigh
Neurology & Psychiatry — Myron G. Sandifer, M.D., N. C. Memorial Hospital,

Chapel Hill
Radiology — Isadore Meschan, M.D., Bowman Gray School of Medicine,

Winston-Salem
Pathology — Roger W. Morrison, M.D., 65 Sunset Parkway, Asheville
Anesthesia — Charles E. Whitcher, M.D., Route 1, Pfafftown
Orthopedics & Traumatology — CHALMERS R. CARR, M.D., 1822 Brunswick Avenue

Charlotte
Student AMA Chapters — Mr. John Feagin, Duke University School of Medicine,

Durham

PAPAIN

IS THE

KEY

to complete, thorough
vaginal cleansing

mucolytic, acidifying,
physiologic vaginal douche

The papain content of Meta Cine is the key
reason why it effects such complete cleansing of
the vaginal vault. Papain is a natural digestant,
and is capable of rendering soluble from 200-
300 times its weight of coagulated egg albumin.
In the vagina, papain serves to dissolve mucus
plugs and coagulum.

Meta Cine also contains lactose — to promote
growth of desirable Doderlein bacilli — and
methyl salicylate, eucalyptol, menthol and
chlorothymol, to stimulate both circulation and
normal protective vaginal secretions. Meta
Cine's pleasant, deodorizing, non-medicinal fra-
grance will meet your patients' esthetic demands.

Supplied in 4 oz. and 8 oz. containers, and in
boxes of 30 individual-dose packets. Dosage:
2 teaspoonfuls, or contents of 1 packet, in 2
quarts of warm water.

lb

HKAYTIN

BRAYTEN PHARMACEUTICAL COMPANY Chattanooga 9, Tennessee

When summertime
chores bring on

LOW BACK PAIN

Brand of chlormezanone

relaxes skeletal

muscle spasm -

ends disability.

How Supplied: Trancopal Caplets®

200 mg. (green colored, scored), bottles of 100.
100 rag. (peach colored, scored) , bottles of 100.

Dosage: Adults, 200 or 100 mg. orally three or four
times daily. Relief of symptoms occurs in from
fifteen to thirty minutes and lasts from four to six
hours.

References: 1. Lichtman, A. L.: Kentucky Acad. Gen.
Pract. J. 4:28, Oct., 1958. 2. Lichtman, A. L.: Scientific
Exhibit, Internat. Coll. Surgeons, Miami Beach, Fla., Jan.
4-7, 1959. 3. Gruenberg, Friedrich: Current Therap. Res.
2:1, Jan., 1960. 4. Kearney, R. D.: Current Therap. Res.
2:127, April. 1960.

LABORATORIES
New York 18, N.Y.

hen any of a host of summer activities brings on low back pain
associated with skeletal muscle spasm, your patient need not be dis-
abled or even uncomfortable. The spasm can be relaxed with
Trancopal, and relief of pain and disability will follow promptly.

Lichtman1,2 used Trancopal to treat patients with low back pain,
stiff neck, bursitis, rheumatoid arthritis, osteoarthritis, trauma, and
postoperative muscle spasm. He noted that Trancopal produced
satisfactory relief in 817 of 879 patients (excellent results in 268,
good in 448 and fair in 101).

Gruenberg3 prescribed Trancopal for 70 patients with low back
pain and observed that it brought marked improvement to all. "In
addition to relieving spasm and pain, with subsequent improvement
in movement and function, Trancopal reduced restlessness and
irritability in a number of patients."3 In another series, Kearney4
reported that Trancopal produced relief in 181 of 193 patients
suffering from low back pain and other forms of musculoskeletal
spasm.

Trancopal enables the anxious patient to work or play. According
to Gruenberg, "In addition to relieving muscle spasm in a variety
of musculoskeletal and neurologic conditions, Trancopal also exerts
a marked tranquilizing action in anxiety and tension states."3
Kearney4 found ". . . that Trancopal is the most effective oral skeletal
muscle relaxant and mild tranquilizer currently available."

Side effects are rare and mild. "Trancopal is exceptionally safe for
clinical use."3 In the 70 patients with low back pain treated by
Gruenberg,3 the only side effect noted was mild nausea which oc-
curred in 2 patients. In Lichtman's group, "No patient discontinued
chlormethazanone [Trancopal] because of intolerance."1

July, 1960

ADVERTISEMENTS

XI

ALL OVER AMERICA!

KENTwiththe MICRONITE FILTER

IS SMOKED BY
MORE SCIENTISTS and EDUCATORS

than any other cigarette!*

FIVE TOP BRANDS

OF

CIGARETTES

SMOKED BY AMERICAN

SCIENTISTS

15.3%

10.5%
7.9%

BRAND -F- m— 1

7.6%

BRAND "B -"»■—'"■■'

7.3%

■■K

FIVE TOP BRANDS OF CIGARETTES
SMOKED BY AMERICAN EDUCATORS

BRAND "G" mil ill Ml

BRAND "E"
BRAND ~A"
BRAND "F"

THIS does not constitute a
professional endorsement
of Kent. But these men, like
millions of other Kent smokers,
smoke for pleasure, and choose
their cigarette accordingly.

The rich pleasure of smoking
Kent comes from the flavor
of the world's finest natural
tobaccos, and the free and
easy draw of Kent's famous
Micronite Filter.

If you would like the booklet, "The Story of Kent", for your
own use, write to: P. Lorillard Company — Research De-
partment, 200 East 42nd Street, New York 17, New York.

INO-1IZI,
REOULAI 1UJ
01 CRUIH-FIOOF 10ft

For good smoking taste, WM 1S1¥

it makes good sense to smoke IBLIU [Hill

jf. Results ot a continuing study of cigarette preferences, conducted by 0'Bnen Sherwood Associates, NT., NY.
A PRODUCT OF P LORILLARD COMPANY FIRST WITH THE FINEST CIGARETTES THROUGH LORILLARD RESEARCH

O ':.,' ..^A'jia

"

life
/saving

in / many cases . .

-V

NJECTION

...a highly potent,
bactericidal antibiotic
for combating staph and
gram negative infections

Kanamycin Sulfate Injectton

. . .well tolerated when
used on a properly individ-
ualized dosage schedule
which does not induce
excessive blood levels

"In many instances its effect has been dramatic and life saving . . ."*

"Six of the patients who survived were considered to be terminally ill at the time
kanamycin was started but showed dramatic improvement and eventual complete
recovery

»2

". . . indeed, the results [with kanamycin] are the most remarkable ever achieved
with otherwise fatal staphylococcal infections that we have ever seen."3

"There appears to be no doubt that kanamycin has been lifesaving in those in-
stances in which organismal resistance precludes the use of other antimicrobials."4

Information on dosage, administration and 'precautions
contained in package insert or available on request.

SUPPLY: Kantrex Injection, 0.5 Gm. kanamycin (as sulfate) in vial containing 2 ml. volume.
Kantrex Injection, 1.0 Gm. kanamycin (as sulfate) in vial containing 3 ml. volume.

REFERENCES: 1. Yow, E. M.: Practitioner 182:759, 1959. 2. Yow, M. D., and Womack, G. K.: Ann. N. Y. Acad. Sci. 76:363,
1958. 3. Bunn, P. A., Baltch, A., and Krajnyak, 0.: Ibid. 76:109, 1958. 4. Council on Drugs, J.A.M.A. 172:699, 1960.

BRISTOL LABORATORIES, SYRACUSE, NEW YORK

7

Vhen STRESS accompanies secondary anemias

IBIlIWi

gtjgfc

us Fumarate

ISO mg

180 mg. Fe

in B-12 with Intrinsic Fictor
ntrate, Non-Inhibitory

1/9 USF
Oral Uni

1/3 USP
t Oral Unit
(6 meg. B-12)

4 meg B-12

bic Acid

100 mg

300 mg.

300 mg.

Tine Mononitrate (B-l)

3 3 mn

10 mg.

10 mg.

avin (B-2>

T '■ mg

10 mg.

10 mg.

oxine Hydrochloride (B-6)

0.67 mg

2 0 mg.

2.0 mg.

namide

33.3 mg

100 mg.

100 mg.

jm Pantohenate

6.67 mg

20 mg.

20 mg.

Acid

0.5 mg

1.5 mg.

1.5 mg.

w (From Copper Sulfate)

3.0 mg

9.0 mg.

anese (From Mn Sulfate)

3.0 mg

9.0 mgr.

t (From Cobalt Sulfate!

0.05 mg

0.15 mg.

(From Zinc Sulfate)

0.3 mg

0.9 mg.

This unique comprehensive formula provides a broad new concept in the treatment
of anemias, in convalescence, and in the prevention and treatment of nutritioi
deficiencies. As indicated by its formula, dosage control is more easily maintains
with HEMOTREXIN. All treatable secondary' anemias, especially when aceonv
panied by stress conditions, as in anemias of pregnancy, convalescence, adolescence
post-infection anemias, anemias following drug therapy, and in the prevention am
treatment of nutritional deficiencies . . . respond favorably to HEMOTREXIN.

DOSAGE

Adults: one tablet three times daily after

meals.
Children: one to three tablets according to
age.

"r?nrpr7JT7r7orPT7 nr?/^7

SAMPLES AND
LITERATURE
GLADLY SENT
UPON REQUEST.

Raise the Pain Threshold

Phenaphen with Codeine provides

intensified codeine effects with

control of adverse reactions.

It renders unnecessary (or postpones)

the use of morphine or addicting

synthetic narcotics, even in

many cases of late cancer..

Three Strengths —

PHENAPHEN NO. 2

Phenaphen with Codeine Phosphate Vt gr. (16.2 mg.)

PHENAPHEN NO. 3

Phenaphen with Codeine Phosphate Vi gr. (32.4 mg.)

PHENAPHEN NO. 4

Phenaphen with Codeine Phosphate 1 gr. (64.8 mg.)

Aho-

PHENAPHEN In each cap.ule

Acetylsalicylic Acid 2% gr. . (162 mg.)

Phenacetin 3 gr (194 mg.)

Phenobarbital % gr. (16.2 mg.)

Hyoscyamine sulfate (0.031 mg.)

PHENAPHEN with CODEINEh

Rgbins |

A. H. ROBINS CO.. INC., RICHMOND 20. VIRGINIA
Ethical Pharmaceuticals of Merit since 1878

• •

— %

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s*~e

-A » •. •. ;. • -:::*■■* r \'h \ •■:-'..• /*s*V

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:•.••■•*• '. .:• * .•:."/... ■•'.' •'••: •••'••' •• V *' .'.••'5/-.r;.:- ."• *- ; •

■•..•/.•.". •'.•..;•. '.*• ■'■:■'• :••'•■ \V . ^.Vi- »V. ; . , / A-S .•''•''£".• .*,.' -

• ••'.•* .•*. .• V'i'v :'•;'.•'■ •'.'••'.:•;*• .' ^\".1'°- •.•.'.'•"/"/.•—•I- <".'•..■• ..7- ' •'•*/ *. • ■**•

■•'. ...••:■•.'• •••■v.-.:..-." -'•'• -v-v* •*.- •'•• •' -.•''•••••:• • ■ •-.-. "• .'-.♦•
:••• .•••;v//-.Vv-'sV-.". '•.;;» v •*.. ...•••/•:;;•••. •• "•>:-:.•;.-'

■-.'••"i: ::■/.'• '.••••' r-'.." './•>'• ;'..•;•: .•*/•.-.•/ :: •. •: -v. -.*• ■;•/.' -.•..•/ '
."■•'' . •'.-■ • ■ .•* '■• .'•.'''..•'"'■•• '.•■■• ' *♦.»•' .

Triaminic

...relief from pollen allergies

more complete than antihistamines alone... more thorough than nose drops or sprays

The miseries of respiratory allergy can be relieved so effectively
with Triaminic.15 Triaminic contains two antihistamines plus
the decongestant, phenylpropanolamine, to help shrink the en-
gorged capillaries, reduce congestion and bring relief from rhin-
orrhea and sinusitis.1 Oral administration distributes medication
to all respiratory membranes without risk of "nose drop addic-
tion" or rebound congestion.-3

Each Triaminic timed-release Tablet provides:

Phenylpropanolamine HCI 50 mg.

Pheniramine maleate 25 mg.

Pyrilamine maleate 25 mg.

also available:

TRIAMINIC JUVELETSS Vi the formulation of the Triaminic Tablet with timed-release action.

TRIAMINIC SYRUP each teaspoonful (5 ml.) provides Va the formulation of the Triaminic Tablet.

References: 1. Fabrlcant, N. D.: E. E. N.T. Monthly 37:460 (July) 1958. 2. Lhotka. F. M.: Illinois M.J. 112 259
(Dec ) 1957. 3. Farmer, D. F.: Clin. Med. 5:1183 (Sept.) 1958. 4. Fuchs, M.; Bodi.T.: Mallen, S. R.; Hernando. L,
and Moyer, J.H.: Antibiotic Med. &. Clin. Ther. 7:37 (Jan) 1960. 5. Halpern, S. R.. and Rabinowitz, H.: Ann.
Allergy 18:36 (Jan.) 1960.

«4jfl ^^ . first— the outer layer dissolves
jr^i "^^^^ within minutes to produce

Relief Is prompt and prolonged jj \^^^\ J 3 to 4 hours of relief

because of this special BP JL /" x

Pl^fc^^j^^ ^ then — the core disintegrates

timed-release action \§j/p ^^T~^™Bt0 give 3 10 4 mcre

S??????0 8

* * S i 8 * *

* ? 2 S ?

' s
i
s

GONORRHEA IS ON THE MARCH AGAIN...

a new timetable for recovery:

only six capsules of TETREX can cure a male patient with gonorrhea in just one day4

Tet

®

U.S. PAT. NO. 2. 791,609

THE ORIGINAL TETRACYCLINE PHOSPHATE COMPLEX

TETREX CAPSULES. 250 mg. Each capsule contains:
TETREX (tetracycline phosphate complex equivalent to
tetracycline HCI activity) - 250 mg.
DOSAGE: Gonorrhea in the male -Six capsules of
TETREX in 3 divided doses, in one day.

v Marmell, M., and Prigot, A.: Tetracycline phosphate complex in the treat-
ment of acute qonococcal urethritis in men. Antibiotic Med. & Clin. Ther.
6:108 (Feb) 1959.

BRISTOL LABORATORIES,

SYRACUSE, NEW YORK

THE

REALMS

OF THERAPY

| fBASSPDRT
TO, -
TRANQUILH*Y

ATTAINED
WITH

ATA RAX

(brand of hydroxyzine)

V World-wide record of effectiveness-over 200 labora-
tory and clinical papers from 14 countries.
Widest latitude of safety and flexibility-no serious
adverse clinical reaction ever documented.
Chemically distinct among tranquilizers— not a pheno-
thiazine or a meprobamate.
Added frontiers of usefulness— antihistamine; mildly
antiarrhythmic; does not stimulate gastric secretion.

Special Advantages

unusually safe; tasty syrup,
10 mg. tablet

well tolerated by debilitated
patients

useful adjunctive therapy for
asthma and dermatosis; par-
ticularly effective in urticaria

W IN

i HYPEREMOTIVE §

does not impair mental acuity

Supportive Clinical Observation

". . . Atarax appeared to reduce anxiety
and restlessness, improve sleep pat-
terns and make the child more amen-
able to the development of new pat-
terns of behavior. . . ." Freedman, A.
M.: Pediat. Clin. North America 5:573
(Aug.) 1958.

". . . seems to be the agent of choice
in patients suffering from removal dis-
orientation, confusion, conversion hys-
teria and other psychoneurotic condi-
tions occurring in old age." Smigel,
J. 0., et al.: J. Am. Geriatrics Soc.
7:61 (Jan.) 1959.

"All [asthmatic] patients reported
greater calmness and were able to
rest and sleep better... and led a
more normal life. ... In chronic and
acute urticaria, however, hydroxyzine
was effective as the sole medica-
ment." Santos, I. M., and Unger, L:
Presented at 14th Annual Congress,
American College of Allergists, Atlan-
tic City, New Jersey, April 23-25, 1958.

L

". . . especially well-suited for ambula-
tory neurotics who must work, drive
a car, or operate machinery." Ayd, F.
J., Jr.: New York J. Med. 57:1742 (May
15) 1957.

New York 17, N.Y.

Division, Chas. Pfizer & Co., Inc.

Science for the World's Weil-Being

.and for additional evidence

Bayart, J.: Acta paediat. belg.
10:164, 1956. Ayd, F. J., Jr.: Cal-
ifornia Med. 87:75 (Aug.) 1957.
Nathan, L. A., and Andelman, M.
B.: Illinois M. J. 112:171 (Oct.)
1957.

Settel, E.: Am. Pract. & Digest
Treat. 8:1584 (Oct.) 1957. Negri,
F.: Minerva med. 48:607 (Feb.
21) 1957. Shalowitz, M.: Geri-
atrics 11:312 (July) 1956.

Eisenberg, B. C: J.A.M.A. 169:14
(Jan. 3) 1959. Coirault, R„ et al.:
Presse mki. 64:2239 (Dec. 26)
1956. Robinson, H. M.. Jr., et al.:
South. M. J. 50:1282 (Oct.) 1957.

^^

Garber, R. C, Jr.: J. Florida M.
A. 45:549 (Nov.) 1958. Menger,
H. C.i New York J. Med. 58:1684'
(May 15) 1958. Farah, L: Inter-
nat. Rec. Med. 169:379 (June)
1956.

SUPPLIED: Tablets, 10 mg., 25
mg., 100 mg.; bottles of 100.
Syrup (10 mg. per tsp.), pint
bottles. Parenteral Solution: 25
mg./cc. in 10 cc. multiple-dose
vials; 50 mg./cc. in 2 cc. am-
pules.

J

IN ORAL CONTROL OF PAIN

ACTS FASTER-usua I ly within 5-15 minutes. LASTS LONGER-usually
6 hours or more. MORE THOROUGH RELIEF- permits uninterrupted
sleep through the night. RARELY CONSTIPATES-excellent for
chronic or bedridden patients.

average adult dose: 1 tablet every 6 hours. May be habit-forming. Federal law
permits oral prescription.

Each Percodan* Tablet contains 4.50 mg. dihydrohydroxycodeinone hydro-
chloride, 0.38 mg. dihydrohydroxycodeinone terephthalate, 0.38 mg. homa-
tropine terephthalate, 224 mg: acetylsalicylic acid, 160 mg. phenacetin, and
32 mg. caffeine.

Also available — for greater flexibility in dosage - Percodan®-Demi: The
Percodan formula with one-half the amount of salts of dihydrohydroxyco-
deinone and homatropine.

Literature? Write

ENDO LABORATORIES

Richmond Hill 18, New York

$«S

Percodan

Salts of Dihydrohydroxycodeinone and Homatropine, plus APC

Tablets

FOR PAIN

•U.S. Pat. 2,628,185

July, 1960

ADVERTISEMENTS

XXI

I

ECLOMYCIN NOTES:

Demethylchiortetracycllne Ledefle

pathogen

sensitivity

In addition to the expected broad-
spectrum range of effectiveness,
Declomycin has demonstrated ac-
tivity against strains of Pseudomo-
nas, Proteus and A. aerogenes un-

responsive

refractory

antibiotics.

1. Finland, M.; Hlrsch, H. A., and Kunin, C.
M.: Read at Seventh Annual Antibiotics Sym-
posium, Washington, D. C, November 5,
1959. 2. Hirsch, H. A.; Kunin, C. M., and
Finland, M.: Miinchen. med. Wchnschr. To be
published. 3. Roberts, M. S.; Seneca, H., and
Lattimer, J. K.: Read at Seventh Annual
Antibiotics Symposium, Washington, D. C,
November 5, 1959. 4. Vineyard, J. P.; Hogan,
J., and Sanford, J. P.: Ibid.

Capsules, 150 mg. — Pediatric Drops, 60
mg./cc. — New Syrup, cherry-flavored, 75 /
mg./5 cc. tsp., in 2 fl. oz. bottle — 3-6 mg.
per lb. daily in four divided doses.

A.
aerogenes

or highly

Xto other

reeudomonas)'

GREATER ACTIVITY... FAR LESS ANTIBIOTIC ... SUSTAINED-PEAK CONTROL ... "EXTRA-DAY" PROTECTION AGAINST RELAPSE

LEDERLE LABORATORIES, a Division of AMERICAN CYANAMID COMPANY, Pearl River, New York

XXII

NORTH CAROLINA MEDICAL JOURNAL

July, I960

For topical infections,

choose a 'B. W. & Co." 'SPORIN'. . .

.— /

CORTISPORIN

brand OINTMENT

Combines the anti-
inflammatory effect
of hydrocortisone with
the comprehensive
bactericidal action
of the antibiotics.

Each gram contains: Neomycin Sulfate 5 mg.

'Aerosporin'® brand Polymyxin B Sulfate 5,000 Units Hydrocortisone (1%) 10 mS-

Zinc Bacitracin 400 Units in a special petrolatum base.

Each gram contains:

'Aerosporin'® brand Polymyxin B Sulfate 5,000 Units Zinc Bacitracin

Neomycin Sulfate 5 mg. in a special petrolatum base.

400 Units

V..

POLYSPORIN'

brand ANTIBIOTIC OINTMENT

Offers combined anti-
biotic action for treating
conditions due to suscep-
tible organisms amenable
to local medication.

u

Each gram contains:

'Aerosporin'® brand Zinc Bacitracin 500 Units

Polymyxin B Sulfate 10,000 Units in a special petrolatum base.

BURROUGHS WELLCOME & CO. (U.S.A.) INC., Tuckahoe, N. Y.

• •••••

isual medications
act only here

u w|

p» • •

elief in HAY FEVER

*% .

«

.**)

■

3««

NEW

\

• •

acts here

to relieve both nasal

and chest discomfort

»» •••«

',

BHL-

I m L» V v

/upper respiratory decongestion
and bronchial decongestion

Many hay fever patients also experience chest discomfort. For these patients,

new ISOCLOR provides relief along the entire respiratory tract.

COMBINES the nasal and bronchial decongestant action of d-isoephedrine with

the histamine blocking action of chlorpheniramine.

RELIEVES the discomforts of rhinorrhea, itching, sneezing, hyperlacrimation

and post nasal drip— let s the patient get a full night's rest— with minimal daytime

drowsiness, CNS or pressor stimulation.

TABLETS AND SYRUP for adults and children . . .
COMPOSITION: Per tablet Per 5 ml. syrup

Chlorpheniramine maleate 4 mg. 2 mg. - _ . . . — P T n II T

d-lsoephedrine HCI 25 mg. 12.5 mg. AKNAK'olUNt

DOSE: Tablets: One tablet 3 or 4 times daily. Syrup: Children: 3-6 yrs. Laboratories InC

'/; tsp. t.i.d.; 6-12 yrs. 1 tsp. t.i.d.; Adults: 2 tsp. t.i.d.

AVAILABLE: Tablets: Bottles of 100. Syrup: Pint bottles. Mt. Prospect, Illinois

\j*t-fifjfl

V':

fi|nH '^iM

K ■

1 ^K ■

1 '■ lifaff ^A

3Ht.3B»,

ffiH^

^V*tr~'.

'8[* ■ -

!«

"Tfo amc^tf of treating hypertension with a potent oral diuretic in combination
with one or more of the sympathetic depressant drugs is a new one."

Salutensin samples available on request

Gentlemfn: Please send me a complimentary supply of
Salutf.nsin Tablets.

Dr..

Street_
City

_ZONE_

_State_

Signature.

Send coupon to: Bristol Laboratories, Syracuse, New York.

REFERENCES: 1. Gifford, R.
W., Jr., In Hypertension, ed. by
J. H. Moyer, Saunders, Philadel-
phia, 1959, p. 561. 2. Moyer,
J. H.: Ibid. p. 299. 3. Brodie,
B. B.: In Hypertension, Vol. VII,
Proceedings Council for High
Blood Pressure Research, Am.
Heart Assn., ed. by F. R. Skelton,
1959, p. 82. 4. Wilkins, R. W.:
Ann. Int. Med. 50:1, 1959. 5.
Freis, E. D.: In Hypertension, ed.
by Moyer, op. cit., p. 123. 6.
Ford, R. V., and Nickell, J.: Ant.
Med. » Clin. Ther. 6:461, 1959.
7. Fuchs, M., and Mallin, S. R.:
Int. Red. Med. 172:438, 1959.

NEW

For the "multi-system disease"2 HYPERTENSION,
an integrated multi-therapeutic antihypertensive...

A multi-system disease such as essential hypertension often requires a multi-therapeutic approach (or satisfactory
control. Salutensin combines in balanced proportions three clinically proven antihypertensives. These components
act through three different physiologic mechanisms to offer greater therapeutic benefits while minimizing the risk of
side effects sometimes observed in patients on single drug therapy at maximally effective doses. The components in
each Salutensin Tablet:

Saluron (hydroflumethiazide Bristol) — a saluretic-antihypertensive agent postulated to lower elevated blood pres-
sure by affecting vascular reactivity to a still unknown pressor mechanism 50 mg.

Reserpine — a tranquilizing drug with peripheral vasorelaxant effects, which have been described as a "chemical

sympathectomy"3 0.125 mg.

Protoveratrine A—"& potent hypotensive drug"4 which is "well tolerated" in combination with rauwolfia;4 a cen-
trally mediated vasorelaxant that produces "the most physiologic, hemodynamic reversal of hypertension"5.. ..0.2 mg.

Indications: Essential hypertension; hypertensive cardiovascular disease; insufficient response to a single or dual
antihypertensive agent; partial or complete replacement of potentially more toxic agents.

Salutensin should be used cautiously in hypertensive patients with renal insufficiency, particularly if such patients
are digitalized.

Dosage: Usual adult dose 1 tablet twice daily. Detailed information on dosage and precautions in official package
circular or available on request.

ply: Bottles of 60 scored tablets.

A sustained-action foundation drug for an antihypertensive regimen

saLuroN

sustained-action hydroflumethiazide 'Bristol'

Saluron is an economical, well-tolerated salutensive agent — saluretic and antihypertensive — for
foundation drug in the treatment of hypertension. In mild to moderate hypertension, Saluron
adequate by itself. It has been described as "a distinct advantage in the manifestations of hypert
and "a marked advancement in the field of diuretic therapy."7

Dosage: Usually 1 tablet daily. Full information in official package circular.

SurrLY: Scored 50-mg. tablets, bottles of 50.

BRISTOL LABORATORIES, Syracuse, New York

use as a
often is
ension"6

XXVI NORTH CAROLINA MEDICAL JOURNAL July, 1960

FOR

SULFONAMIDE
THERAPY

NEW

DR4P
DOSAGE
F*RM
CHERRY
FLAVORED

N Acetyl Sulfamethoxypyridazine

PEDIATRIC DROPS

I I single, daily-dose effectiveness □ rapid,
sustained action against sulfa-susceptible
organisms □ 125 mg. sulfamethoxypyrida-
zine activity per cc. in 10 cc. squeeze bottle

Dosage: First day, 2 cc. (250 mg.) for each 20 lbs. body weight; thereafter, 1 cc.
(125 mg.) for each 20 lbs- Should be given once a day immediately after a meal.

LEDERLE LABORATORIES, a Division of AMERICAN CYANAMID COMPANY, Pearl River, New York

■ .•

Of course, women like "Premarin"

rpHERAPY for the menopause syn-
■*■ drome should relieve not only the
psychic instability attendant the con-
dition, but the vasomotor instability
ot estrogen decline as well. Though
they would have a hard time explain-
ing it in such medical terms, this is
the reason women like "Premarin."
The patient isn't alone in her de-

votion to this natural estrogen. Doc-
tors, husbands, and family all like
what it does for the patient, the wife,
and the homemaker.

When, because of the menopause,
the psyche needs nursing— "Premarin"
nurses. When hot flushes need sup-
pressing, "Premarin" suppresses. In
short, when you want to treat the

whole menopause, (and how else is
it to be treated?), let your choice be
"Premarin," a complete natural es-
trogen complex.

"Premarin," conjugated estrogens
(equine), is available as tablets and
liquid, and also in combination with
meprobamate or methyltestosterone.
Ayerst Laboratories* New York /~~~\ 3
16, N. Y. • Montreal, Canada \^»0 "

^AL potassium phenethicillin

YNCI

J

LIN

(Potassium Penicilliu-152)

higher peak blood levels

than with potassium penicillin V

higher initial peak blood levels
than with intramuscular penicillin G

increased dosage increases
serum levels proportionally

superior to other penicillins
in killing many staph strains

A dosage form to meet the individual
requirements of patients of all ages
in home, office, clinic and hospital:

Syncillin Tablets-250 nig. . . . Syncillin Tablets-125 mg.

Syncillin for Oral Solution — 60 nil. bottles— when reconstituted,
125 nig. per 5 ml.

Syncillin Pediatric Drops — 1.5 Gni. bottles. Calibrated dropper
delivers 125 nig.

Complete information on indications, dosage and precautions is
included in the official circular accompanying each package.

clears ringworm orally regardless of duration
or previous resistance to treatment

spares the patient— embarrassment of epilation and
skullcaps, difficulty and ineffectiveness of topical
medications, potential hazard of x-ray treatments

XXX

NORTH CAROLINA MEDICAL JOURNAL

July, I960

Co-Pyronir

keeps most allergic patients
symptom-free around the clock

Many allergic patients require only one Pulvule® Co-Pyronil
every twelve* hours, because Co-Pyronil provides:

• Prolonged antihistaminic action

• Fast antihistaminic action

plus

• Safe, effective sympathomimetic therapy

*Unusually severe allergic conditions may require more fre-
quent administration. Co-Pyronil rarely causes sedation and,
even in high dosage, has a very low incidence of side-effects.

Supplied as Pulvules, Suspension, and
Pediatric Pulvules.

Co-Pyronil" (pyrrobutamine compound, Lilly)

ELI LILLY AND COMPANY • INDIANAPOLIS 6, INDIANA, U.S.A.

658012

North Carolina Medical Journal

Owned and Published by
The Medical Society of the State of North Carolina

Volume 21

July, 1960

No. 7

Presidents Inaugural Address

Amos N. Johnson, M.D.
Garland

I am grateful to you for having elected
me to be your president. I repeat the words
of Dr. Paul McCain on the occasion of his
inauguration: "To have been selected and
elected to leadership by those people who
know you best, your fellow physicians, is
the highest honor that can come to anyone" ;
and I am grateful for it. As I now assume
this responsibility and honor, I am mindful
of many things.

I am mindful of the constant and contin-
uous change that is going on in this world
and of the rapidity with which events move
| from day to day.

I am also mindful that there is a cancer
eating at Medicine continuously — a social,
a political, and an economic cancer that
we must watch and attempt to eradicate.
It is invading the profession from the
periphery, from the heart, from the inside,
from within Medicine itself.

I am mindful that when one person or
one group loses its freedom, the freedom of
all people is weakened; that abject and un-
reasoning conformity is the first symptom
of mediocrity and eventual decay. Someone
said that he who dares stick his head above
the flowing tide of mediocrity is sure to
have something thrown at him, but I say to
you that it is only by continued, tireless ef-
fort to rise above the commonplace and to
produce something of excellence that one
attains success. Therefore I pledge to you
that this year I will make every effort, with
your help and the help of our capable staff
in Raleigh, to keep the head of Medicine
above the level of mediocrity, even though
I may be fired upon. And, in the sniping at
me, medicine may be jarred a bit, but we
will engage our enemy and find his position
and strength wherever he is recognized.

Read before the Second General Session, Medical Society of
the State of North Carolina. Raleigh, May 11. 1960.

Legislative Issues
I must mention some of the issues which
we will have to face this year. You have
heard the discussions relative to legislation
affecting medicine. In this day of govern-
ment coddling minority groups, medicine is
the whipping boy. Why? Because the poli-
ticians who run our country think that
more votes can be gained by maligning us
and making us the villains than by shower-
ing us with favors. So we are a unique min-
ority who must be constantly alert to tell
our story to all with whom we come in con-
tact. Today's trend in Washington, as de-
picted on television, radio and the press, is
for Government to be all things to all peo-
ple, to give everything to everybody. That
is why we must be diligent in making our
cause known. We must educate and in-
fluence our politicians before they give
away the privileges and financial security
of all the people in this country.

Integration of Negro Physicians
Concerning the integration of Negro
physicians into the Medical Society of the
State of North Carolina, I have secured the
original copy of the report filed by the com-
mittee appointed by President Zack Owens
to study this problem. In brief, the report
states that a thorough study and meeting
of minds between this committee and em-
powered representatives of the Old North
State Medical Society resulted in the con-
clusion that there was a difference in the
social structure of the races which pre-
cluded integration at a social level, but
that there was a need and a desire to make
the scientific facilities of this Society avail-
able to physicians of the Negro race. A
statement of agreement was then reached : a
statement which gave these colored phy-
sicians every thing they asked and every
thing they implied they needed. They were
given access to the American Medical As-

262

NORTH CAROLINA MEDICAL JOURNAL

July, 1960

sociation and national specialty boards
through scientific membership in our State
Society; access to the North Carolina ex-
amining and licensing board by the priv-
ilege of nominating candidates and voting
in these elections.

After all this, we have two scientific
members. Every Negro doctor in North
Carolina could belong to our Society and
could be sitting there with you today ; how-
ever, of this privilege only two have availed
themselves, and neither of them have I
ever seen at a scientific session. After the
original agreement was reached, their atti-
tude quickly changed, probably touched by
an outside influence persuasive enough to
make them decide that they didn't get what
they really wanted the first time. Now,
after a short four or five years, they come
back and want full membership.

I say to you that it is not we, the mem-
bers of the Medical Society of the State of
North Carolina, who will bear the onus of
what will happen as a result of the un-
pleasantness that is sure to come. We have
not broken the faith ; they, the members of
the Old North State Medical Society, have
broken the faith under the pressure and
duress of the NAACP, whose sole purpose
is to foment trouble, unrest and disorder.

That brings us up to the point at hand.
You take my word that what I have told you
is true, that we went the full distance, the
last mile. They want to dance with us, they
want to sit at our banquet tables, they
want to associate with us socially. Now,
maybe it is all right for them to want that.
I cannot judge, since I cannot put myself
in their position. My perspective must
necessarily be purely objective. But when
I go back and think of what is basically
right and on what grounds they have to de-
mand this, I think of other creatures of na-
ture. The tiger doesn't consort with the
lion when sundown comes. Each goes to
his own den. The fox doesn't knock on the
kennel door to lie down with the hound,
though they are closely related. The duck
and swan do not fly North together. I do
not know that there is any sociologic or bio-
logic law that says we must integrate two
elements of our society that are presently
as separate and diverse as are these two
races.

We now have the problem of what to do.
First, I propose to reactivate and enlarge
the committee appointed by Dr. Owens. I
propose to strengthen it, to confer with it
and ask it then to study and recommend
what we can do as a Society to meet this
situation. It occurs to me that we can do
two things : We can stand our ground, for
I cannot see that we have erred. We can
say to our Negro physicians : "You can
have scientific membership. That entitles
you to participate, nominate, and vote. That
entitles you to all privileges except social
functions." Or, we can do as other groups
have done. We can leave this organization,
the Medical Society of the State of North
Carolina, exactly as it is now and, without
change of constitution or by-laws, omit all
social functions. We can then, by whatever
maneuver is necessary, make membership
in the Society tie in with license to practice
medicine in North Carolina and require
membership and regular attendance at
meetings. Then we can be assured of hav-
ing our brethren with us for scientific ses-
sions. If we desire to have social functions,
and no doubt we will, this can be accom-
plished by invitation only under the aus-
pice of some other organization.

Other Considerations

There are other things of which I am
mindful. The format of our Annual Meet-
ing will be changed, as authorized by the
House of Delegates. We will hold perhaps
three general sessions in the mornings,
with a program which would have contin-
uity of a sort involving the areas of the
specialty sections. It would be a broad-
spectrum program, and participating in it
would be surgeons, internists, pathologists,
radiologists, and others.

If time permitted, I would discuss with
you in some detail other matters of interest.
However, I will briefly mention one or two
of most interest.

Dr. Wilburt Davison, who is soon to re-
tire as Dean of the Duke University School
of Medicine, is proposing a change in the
accepted plan for the first year internship
in North Carolina. This plan would set up
an acceptable teaching and training pro-
gram in our better community general hos-
pitals. Each of our three medical schools
would, by agreement, discontinue their one
year of internship and run only a residency

July, 1960

263

Amos N. Johnson, M.D.

264

NORTH CAROLINA MEDICAL JOURNAL

July, 1960

training program. This change would chan-
nel, for one year at least, young doctors
through hospitals whose major purpose is
to treat and alleviate disease and suffering.
This could give these young men a better
perspective upon which to decide their fu-
ture interest and training as physicians.
Much work, salesmanship, and persuasion
will be required if this excellent idea is ever
put into practice.

Dr. Wingate Johnson, editor of your
North Carolina Medical Journal, has
assured me that I will be given a page in

every issue of our Journal this year. I
promise you that I will use this page in
each issue to keep you abreast of problems
and progress of our Medical Society as I see
them. Some ideas and proposed innova-
tions may be controversial; however, their
purpose will be to escape from conformity
and mediocrity. I will at all times welcome
comments and ideas from all our member-
ship.

Again I am grateful to you for permit-
ting me the honor of appearing before you.

Bad Politics and Good Medicine Don't Mix

Louis M. Orr, M.D.
Orlando, Florida

It was with a certain amount of sorrow
that I read in the newspapers recently that
Congressman Aime Forand will retire from
Congress at the end of his present term for
reasons of health. As a newspaper report
of the story said : "His doctors wanted him
to quit two years ago." Of course, all of us
hate to see Mr. Forand go. But on the
other hand, as physicians, we are obliged
to regret that he did not follow his doctors'
advice two years ago.

Unfortunately, the legislation that has
become identified with Mr. Forand will not
be retired with him. We know that other
bills providing health insurance for the
elderly — financed through Social Security —
will be around Congress for some time to
come. There seems to be a general belief
among the pseudo-philanthropists in Wash-
ing-ton that the only way to help the aged
meet their medical and hospital bills is to
soak the rest of the population by raising
the Social Security taxes. This belief seems
to be so untouchable that it is now an un-
official creed of some politicians, and any-
one who does not subscribe to it is branded
as inhuman and callous.

As you know, many different bills have
been introduced in both houses of Congress
in recent months to provide some form of
help to the elderly. Those measures which
*veuld saddle the taxpayer and wage-
earner with the bill are enthusiastically
hailed by Forand supporters.

Presented at the President's Dinner, before Medical Society
of the State of North Carolina. Raleigh. May 10. 1960.

From the midst of all the politicking and
pompous oratory surrounding such mea-
sures, one crude fact emerges : Health care
for the aged has become a political issue,
and it will be used to campaign for votes
in the fall. Personally, I regard this as a
wretched example of political expediency.
It has been obvious for several months
that, in the absence of any strong issues,
the coming national elections might be
rather dull this year. Consequently, the
question of health care for the aged has
been seized upon as a seemingly clear-cut
issue . . . something to get emotional about
. . . something to win votes with.

In the course of all this, physicians in
general and the American Medical Associa-
tion in particular have been villified for
not endorsing these measures. Because we
oppose the Forand bill and similar mea-
sures, we are called heartless scoundrels.
It is implied that we are fighting tooth-
and-nail to keep the nation's elderly in a
condition of abject poverty, without medi-
cal care.

Of course this is nonsense. There is no
doubt that we have opposed Forand-type
legislation. However, we have never said
we opposed helping the aged meet their
medical and health expenses. While we are
very willing to consider reasonable pro-
posals which would result in actually help-
ing the aged, we can see no reason why the
government must pick the pockets of the
younger generation to pay for the health
care of the old people. I make the point of

July, 1960

POLITICS AND MEDICINE— ORE

205

our willingness to consider sound measures
because it will clarify what I plan to say-
in a few minutes.

This entire question of government medi-
cine is a radical departure from the tradi-
tions which raised the United States to
such greatness. Throughout history our
nation has championed the voluntary ap-
proach to health and medical care. Our
physicians have functioned on an unre-
stricted, private basis, either as solo prac-
titioners or in a group of doctors forming
a clinic or group practice. We always have
spurned any form of national compulsory
health care.

In recent years, however, our federal
government has been taking an increased
interest in health and medical matters.
This interest has manifested itself along
lines we are convinced would be dangerous
for the health of the nation. For example,
just since 1953 a total of 2,194 health and
medical bills have been introduced in Con-
gress. This total does not include those that
already have been introduced and will be
offered in the second session of the present
Congress.

Veterans' Medical Care Program

I could list any number of examples of
the growing interest of Congress in health
matters, but let us start with the veterans'
medical care program in the United States.
Let us take a quick look at what has hap-
pened.

The original motive for this program
was the desire to provide care for any vet-
eran who had become disabled while serv-
ing his country. Such a desire was, and
still is, a sound, humanitarian motive and
a legitimate obligation of the federal gov-
ernment. Over the last 35 years, however,
the program has been expanded to provide
care for the veteran who suffers a dis-
ability after his discharge from service
and one that has no relation to his military
duty. The reasons for this expansion can
be traced to politically motivated acts of
our Congress, as well as to vigorous pres-
sure by lobbying organizations.

In 1917 legislation was first passed to
provide medical services and supplies to
veterans with service-connected disabilities.
Six years later Congress broke the ice and
authorized care for non-service-coymected
cases, because some beds had become avail-

able through a reduction in the load of pa-
tients with service-connected conditions.
This provision applied only to certain
veterans.

A year later, the doors were opened
wider to include more veterans. Within two
years (1926) 17 per cent of all patients in
veterans hospitals were receiving treat-
ment for diseases or injuries not related to
military service. And in that year the
doors to the veterans hospitals were swung
completely open.

Two years later (by 1928) 49 per cent
of all admissions were for non-service-
connected cases. By 1931 this figure had
jumped to 71 per cent. In 1954 more than
83 per cent of the patients discharged from
veterans hospitals had disabilities not con-
nected with military service.

During the last 30 years the argument
for care for non-service-connected cases
has been that as long as extra or vacant
beds are available, the beds should be used
for indigent veterans who have non-service-
connected disabilities or illnesses. Well, 30
years ago our nation had only 9,500 "ex-
tra" beds. Today there are more than
80,000.

The VA costs have skyrocketed from 37
million dollars in 1934 to 843 million
dollars in 1959. Perhaps even more impor-
tant than the cost of this particular fed-
eral program, however, is the development
of greater federal control of our medical
schools as the private teaching hospitals
drop internships and residencies because
of inability to compete with the VA hospi-
tal inducements. And these are paid for by
our tax dollars. I fear that federal pro-
grams such as this can lead to a large num-
ber of physicians whose total hospital ex-
perience during their education will have
been under the federal eye — from clinical
clerkship to completion of residency.

There are many, many more problems
connected with the veterans program, but
to examine each would take considerable
time. From this brief discussion, however,
you get some idea of the error in allowing
the federal government to expand a legiti-
mate program until it "covers the water-
front."

Health Plans and Social Security
As I mentioned earlier, one of our major
reasons for opposing Congressional health

2lil>

NORTH CAROLINA MEDICAL JOURNAL

July, I960

schemes is because they would be operated
under the Social Security Administration.

When the Social Security Act became
law in 1935, it contained 15 titles covering
a wide range of subjects, including old age
"insurance," aid to the blind, aid to de-
pendent and crippled children, aid to the
needy aged, grants for maternal and child
welfare, and unemployment compensation.

The A.M. A. has not taken any position
before or since 1935 about the wisdom or
desirability of the over-all Social Security
program. In fact, the act might never have
become a matter of concern to the medical
profession had it remained in or near its
original form.

The act was amended drastically in 1939,
particularly in regard to Title II, which
covered old age insurance programs. Few
substantial changes were made between
1939 and 1950. Since then, however, the
act has been amended substantially in
every election year — 1952, 1954, 1956, and
1958.

The original provisions of Title II were
designed to compel the employed worker to
set aside a certain amount of his earnings
for his old age. It applied primarily to
workers in commerce and industry. The act
did not and was not intended to cover self-
employed persons, farmers or professional
people, among others.

Title II was originally limited to lump
sum death benefits and monthly old age
payments for covered employes who had
paid into the system. Four years after
adoption, the act was amended radically to
allow monthly benefits for dependents and
survivors.

In 1950 some 10 million workers were
brought under the protective wings of the
Social Security Act, and in 1954 coverage
was forced on farmers, lawyers, dentists,
and additional farm and domestic em-
ployes. State and local government em-
ployes, ministers, and members of religious
orders were offered a means to accept cov-
erage voluntarily.

The only large groups
by the act are federal
ployes — who have their
program — and physicians.

The A.M. A. has opposed inclusion of
physicians for philosophic and economic
reasons. Our philosophic arguments are

not now covered
government em-
own retirement

based on the theory, history and long-range
prospects for social insurance systems. In
other countries, such schemes have grown
from retirement payments to survivorship
payments to temporary cash sick benefits,
and finally to national compulsory health
insurance.

In the United States, Social Security is
following the same pattern. It has pro-
gressed farther and farther away from its
original purpose of providing financial
protection for aged citizens and has moved
closer and closer to the paternalistic, gov-
ernment concept of "womb-to-tomb" cov-
erage.

Economically, few physicians would bene-
fit from the retirement features of Social
Security since most doctors continue work-
ing long after their sixty-fifth birthdays.
We in the A.M. A. also feel that our ap-
proval of compulsory coverage would tend
to dilute the strength of our continuing
struggle against government medicine via
amendments to the Social Security Act. It
is well known that advocates of federal
medicine have long envisioned the act as a
vehicle for providing all-embracing gov-
ernment health care. This ultimate objec-
tive was openly presented to Congress in
1943 when a national health insurance bill
was introduced. Although it was not
passed, versions of this 1943 legislation
have been presented in every Congress
since then.

From 1948 to 1951 the bills received
their greatest attention. It took a long and
active campaign against this type of legis-
lation by the medical profession and num-
erous other groups to convince Congress
that Americans wanted no part of govern-
ment medicine.

Government Medicine vs.
Voluntary Insurance

In our country, the government's medi-
cal activities are on a massive scale, and
they continue to grow. Last year for all
health programs — research, medical care,
public health — the government spent 62
per cent more than it did five years before.
Programs in 22 separate agencies and de-
partments of the U. S. government range
from cancer research to federal employee
clinics. The total cost last year was about
2 3/4 billion dollars.

I

July, 1960

POLITICS AND MEDICINE— ORR

267

Today nearly 38 million persons are eli-
gible to receive all or part of their medical
care from or through the federal govern-
ment. Both as a physician and as a tax-
payer, I would like to know where this is
going to stop !

In our country, nearly 125 million per-
sons have some form of voluntary, non-
government health insurance. This is about
five out of every seven persons. And more
and more persons are signing up for such
health insurance coverage.

So you see, this coin has two sides — on
one side the federal government is expand-
ing its activities in the medical care field,
while on the other voluntary methods are
providing more and better non-government
health insurance for Americans.

The American Medical Association be-
lieves the voluntary system should be al-
lowed to function freely and to provide for
the health care needs of the American

people. Our opponents sit back and whine:
"Let the government do it."

The medical profession, along with its
many allies in the health field, is trying to
halt the current piecemeal attempts to
bring complete federal control of medical
care and the medical profession. Already
our opponents have made far too many
gains, and the struggle has become a "do
or die" fight to keep the private practice
of medicine alive in the United States.

Conclusion
This, then, is the situation. I can promise
you the A.M. A. will do all in its power to
maintain the free enterprise system, the
private practice system, and the voluntary
approach to health and medical care. We
will do so because these methods have
brought to the American people the highest
possible degree of medical care and knowl-
edge, and it will bring them even greater
care in the future.

Three Great Challenges

Leonard W. Larson, M.D.*
Bismark, North Dakota

As you know, American medicine is en-
tering into a decade that may be its great-
est— or its most disastrous. I am sure you
are well aware of the innumerable chal-
lenges and problems that lie ahead of us,
many requiring our immediate attention. I
want to speak about three of these chal-
lenges.

Medical Education

One which requires careful study and
the positive approach is the task of improv-
ing both the quality and the quantity of
our medical education facilities. Here, we
must plan ahead to maintain an adequate
supply of well trained physicians to meet
the future medical needs of the American
people.

For the past 30 years or more, the pro-
duction of new physicians by our medical
schools has kept up with the nation's grow-
ing population. Times are changing, how-
ever, and we cannot be complacent. Our

Read before the House of Delegates, Medical Society of the
State of North Carolina. Raleigh. May 9. 1960.

♦Chairman of the Board of Trustees. American Medical
Association.

population is increasing. Medical knowl-
edge is expanding. Medical services are be-
coming more complex. And the American
people are showing greater interest in both
the quality and availability of health
services.

In recent years there have been a num-
ber of governmental and private studies
involving the nation's future needs in med-
ical manpower. These studies have pre-
dicted approximately the numbers of phy-
sicians and medical schools required by
1975 and thereafter. Opinions differ on the
variety of statistics and estimates, but
there is agreement on the need for con-
structive planning to meet future require-
ments. Undoubtedly, it will be necessary to
increase the annual number of medical
school graduates.

In December, 1958, the A.M. A. House of
Delegates adopted a statement on the ex-
pansion of American medical education.
Existing medical schools were urged to con-
sider increasing their enrollments and de-
veloping new facilities. The House also en-
couraged the creation of new four-year

268

NORTH CAROLINA MEDICAL JOURNAL

July. 1960

medical schools and two-year basic science
programs by universities which can pro-
vide the proper academic and clinical set-
ting. This expansion, the House empha-
sized, should be based upon careful, con-
tinuing study of the changing needs in all
categories of medical activity.

In addition, the American Medical As-
sociation is encouraging medical schools to
experiment in new programs aimed at
bringing about continual improvement in
the quality and content of their curricula.
For example, the new medical school stand-
ards approved in June, 1957, are intended
to provide flexible guides which will dis-
courage excessive concern with standariza-
tion, but which also will stimulate each
medical faculty to provide a well integrated
educational program in accordance with its
own particular setting.

Recruitment

Meanwhile, the A.M. A. has developed an
expanded career guidance program to re-
cruit qualified, dedicated young people into
the study of medicine. There is definite
need for more intensive effort along these
lines — from the national level all the way
down to the grass roots of the doctor's
home town or neighborhood.

Too many superior students are attracted
by other sciences which, in this age of
electronics, nuclear energy and space ex-
ploration, may seem more exciting or glam-
orous. Others are drawn to careers which
may appear to be more lucrative or more
easily attained, or less demanding. Many
of these young people are discouraged by
the length and cost of a medical education.

Recruitment and expansion in medical
education are, of course, closely related
problems. Recognizing this at the Dallas
meeting last December, the A.M. A. House
of Delegates approved the creation of a
special committee to "present a scholarship
program, its development, administration
and the role of the American Medical As-
sociation in fulfilling it." Such a program
also could include provision for student
loans.

The same committee will study these
seven other major questions:

— How far can medical schools expand
their student bodies while still maintaining
a high quality of medical education?

— What universities can support new
medical schools with qualified students and

sufficient clinical material for teaching —
either on a two-year or a full four-year
basis?

— How to obtain competent medical fac-
ulties?

— How to finance the expansion and es-
tablishment of medical schools?

— How to finance medical education in
the most economical ways commensurate
with high quality training?

— How to recruit well qualified students
into the study of medicine . . . and, finally,

— What are the possibilities of relaxing
some of the geographic restrictions which
affect the admission of medical school stu-
dents?

This new committee was asked to make
its first report at the A.M. A. June meeting.

I urge you and the entire profession —
practicing physicians, teachers, adminis-
trators, researchers, medical societies, pub-
lic health personnel, and medical schools —
to give full cooperation to this study.
Through all possible channels I hope that
you will make your ideas and suggestions
available for this long-range project aimed
at the continuing improvement of Ameri-
can medical services.

Third Parties

Still another challenge to all of us is the
task of bringing about better understand-
ing and cooperation between medicine and
the various third parties involved in med-
ical care plans and health insurance.

You may recall that last June the A.M. A.
House of Delegates, in acting upon the
recommendations of the Commission on
Medical Care Plans, adopted these key
statements on freedom of choice of physi-
cian :

The American Medical Association believes
that free choice of physician is the right of
every individual and one which he should be free
to exercise as he chooses.

Each individual should be accorded the priv-
ilege to select and change his physician at will
or to select his preferred system of medical
care, and the American Medical Association
vigorously supports the right of the individual
to choose between these alternatives.
Those statements were reaffirmed at the
Dallas meeting last December. Some mem-
bers of the profession felt, however, that
there had been a certain degree of misun-
derstanding or misinterpretation of the

July, 1960

THREE CHALLENGES— LARSON

269

action taken last June. Therefore, at the
Dallas meeting, in order to clarify and
strengthen its position on the issue of free-
dom choice, the House also adopted this
additional statement:

Lest there be any misinterpretation, we state
unequivocally that the American Medical Asso-
ciation firmly subscribes to freedom of choice
of physician and free competition anions: phy-
sicians as being prerequisites to optimal med-
ical care. The benefits of any system which pro-
vides medical care must be judged on the degree
to which it allows of, or abridges, such freedom
of choice and such competition.
In other words, the medical profession
recognizes a person's right to choose the
kind of medical care plan he wants — in-
cluding a closed panel plan. At the same
time we believe emphatically that the best
medical care comes about when the patient
has maximum freedom of choice and the
doctor has maximum freedom of profes-
sional action. I think, however, that all of
us must do a much better job of explaining
to the public, and to those who sponsor
medical care or health insurance programs,
just why these principles are vital to high
quality medical service.

I urge you to cooperate sincerely in all
national, state and local activities aimed at
bringing about better understanding. In my
opinion, all of us should bear in mind that
labor unions, industry, and other third
parties in the medical care field are trying
to meet a need under our American system
of private enterprise. It seems to me that
all of us — despite differences of opinion on
certain points — should be working together
in the fight against a common danger : gov-
ernment encroachment which ultimately
could destroy our entire system of private
medicine and voluntary health insurance.

Physician-Hospital Relationships

Another difficult issue which concerns
the entire medical profession is the problem
of physician-hospital relationships. I would
not attempt to cover all the complexities
and variations of this subject, but again I
ivoidd like to report to you on the latest
policy developments in this area.

1951 Guides for Conduct

The A.M.A. House of Delegates, at the
Dallas meeting received a dozen resolutions
on the subject of physician-hospital rela-
tionships. The House did not act upon any

of those resolutions. Instead, to remove any
doubt about its position, the House reaf-
firmed the 1951 "Guides for Conduct of
Physicians in Relationships with Institu-
tions." It also declared that "all subsequent
or inconsistent actions are considered su-
perceded."

If I may, I should like to refresh your
memories by quoting just three brief para-
graphs of those 1951 guides. They sum-
marize general principles which should be
used as a basis for adjusting controversies.
Again I quote :

1. A physician should not dispose of his pro-
fessional attainments or services to any hospital,
corporation or lay body by whatever name called
or however organized under terms or conditions
which permit the sale of the services of that
physician by such agency for a fee.

2. Where a hospital is not selling the services
of a physician, the financial arrangement if any
between the hospital and the physician properly
may be placed on any mutually satisfactory
basis. This refers to the remuneration of a phy-
sician for teaching or research or charitable
services or the like. Corporations or ■ither lay
bodies properly may provide such services and
employ or otherwise engage doctors for those
purposes.

3. The practice of anesthesiology, pathology,
physical medicine and radiology are an integral
part of the practice of medicine in the same
category as the practice of surgery, internal
medicine or any other designated field of medi-
cine."

In addition to reaffirming the 1951
guides, the A.M.A. House of Delegates
recommended that the medical profession
strengthen relationships with hospitals by
action at state and local levels. And, finally,
it also urged the A.M.A. Board of Trustees
to continue to maintain liaison with the
American Hospital Association's Board of
Trustees.

This is a highly complex issue with legal
and professional ramifications which vary
greatly in different states and communities.
In my own view, our best hope for sound,
lasting solutions would be in developing
effective liaison between physicians and
hospitals at the state and local levels.

Both of us — physicians and hospitals —
must think primarily of public welfare and
community responsibility. At the same
time, we doctors have a duty to protect
those ethics and traditions which contri-

270

NORTH CAROLINA MEDICAL JOURNAL

July, 1960

bute to high quality medical care, and
which safeguard the patient against all
possible kinds of exploitation.

I hope that physicians everywhere will
work especially hard to help bring about
better communication and understanding
on the state and local level.

Conclusion

Among the many challenges facing medi-
cine, I have outlined but three — expansion
of our medical education system, relation-
ships with third parties, and physician-hos-
pital relations.

I am confident that my fellow physicians
in North Carolina will measure up to these
long, hard tasks ahead.

Generalized Salivary Gland Virus Disease
In Post>neonatal Life

Charles F. Gilbert, M.D.
Chapel Hill

The clinical and pathologic features of
generalized salivary gland virus disease in
the newborn and adult are well known. It
is not so well known that the disease has a
post-neonatal phase in which the clinical
and pathologic features have not been well
denned. This hiatus in knowledge is due in
part to the rarity with which the disease
occurs in this age group. The following
case is reported to emphasize some features
of the post-neonatal phase of the disease
and to indicate certain diagnostic methods
which have been recently described.

Neonatal Form

The disease in the neonatal age group
has two distinct forms. The first is asymp-
tomatic involvement of the salivary glands,
which is found in 10 to 30 per cent of un-
selected autopsies. The second is the dis-
seminated form, which presents a char-
acteristic clinical picture and has an espe-
cially high incidence in premature infants.
The characteristic findings are jaundice,
hepatosplenomegaly, cutaneous petechiae,
anemia and thrombocytopenia, which are
present at birth or develop within the next
few days. The virus is pantropic, involving
the kidneys, liver and lungs more common-
ly, but frequently is present in the brain,
pancreas, thyroid, gut or other organs. The
mode of dissemination is thought to be
transplacental, occurring early in the ges-
tation. The mechanism liberating the virus
from the mother's salivary glands and caus-
ing the maternal and fetal viremia is un-

From the Department of Pathology. University of North
Carolina School of Medicine. Chapel Hill.

known. An interesting feature is that the
fetal organs receiving a large amount of
blood are involved more frequently and
more extensively. The prognosis in the dis-
seminated disease is grave in contrast to
that in the localized or asymptomatic forms.

Adult Form
Disseminated salivary gland virus dis-
ease is extremely uncommon in adults,
only 35 cases having been published in the
world literature*1'. The disease has been re-
ported only as a complication of a chronic
debilitating disease or its treatment. A pri-
mary neoplasm of the reticuloendothelial
system, refractory anemia, leukemia, renal
disease, and other less common debilitating
diseases have been associated with a ma-
jority of reported cases. The symptoms of
the adult form are those of the primary
disease and of respiratory distress second-
ary to an interstitial pneumonia caused
by the salivary gland virus. The pneumonia
in many cases, both adult and neonatal, is
associated with an infestation by Pneumo-
cystis carinii. This latter organism is
thought to be a protozoan, but its classifica-
tion is uncertain. It is associated with
salivary gland virus disease in up to 50 per
cent of cases.

Post-neonatal Form
The disease in this age group differs
somewhat from that of the newborn and
the adult. It usually presents as a severe
respiratory infection or gastroenteritis.
Renal and hepatic dysfunction occur, but
are less common. The disease is usually
manifest between 2 and 4 months of age,

July, 19G0

SALIVARY GLAND VIRUS DISEASE— GILBERT

271

r

but has a range of 3 weeks to 32 months'2'.
Prematurity has not been correlated with
the development of the disease. As in the
neonatal group, there has been, to date, an
unrelenting progression of symptoms until
death, which may be as long as two or
three months.

The organ involvement in this age group
is similar to that of the newborn. The lungs,
kidneys, and liver are commonly affected,
and other organs less frequently. As in the
present case, the clinical picture is not well
denned, but the disease should be suspected
in children with an unremitting pneumonia
or gastrointestinal disturbance, especially if
hepatosplenomegaly accompanies either.

Development of the fulminant disease
in newborn infants is apparently related to
the fetal viremia and the inability of the
infant to produce antibodies. The same
factors may be present in adults with a
chronic debilitating disease. Most cases in
the post-neonatal period apparently have no
precipitating illness.

Case Report

The patient was a 12 month old white
girl referred to North Carolina Memorial
Hospital because of stiffness and weakness
of the right arm and leg observed since the
age of 3 months. There had also been fail-
ure to attain normal muscular development
and skill.

The child was the product of a normal
pregnancy, but during the nine-hour labor
arrest occurred, and she was delivered with
low forceps. She cried spontaneously and
her color was good. The mother and father
were healthy and had no other children.

On the first clinic visit, at 12 months of
age, she weighed 21 V-> pounds and was 30%
inches in length. The head circumference
was 16 1/4 inches, slightly below the third
percentile for her age. The right elbow and
knee were flexed, and spasticity was pre-
sent in these limbs. The right leg was y2
inch shorter than the left, but mobility at
the hip joints was normal. There was a pos-
sible homonymous hemianopsia on the right.
An electroencephalogram had evidence of
left cerebral damage.

The patient returned at 14 months of age
because of seizures characterized by sudden
dropping forward from a sitting position,
turning of the head toward the left, and
clonic motions of the left leg. These lasted

about 30 seconds. Occasionally vomiting
followed. The seizures had begun 12 days
prior to this visit, and occurred about five
times a clay for the first five days, and
thereafter about every half hour. The fam-
ily physician had prescribed phenobarbital,
following which the seizures became less
frequent. The physical findings were un-
changed. Because the seizures had contin-
ued to occur, the dosage of phenobarbital
was increased and Dilantin was also pre-
scribed.

She was admitted to this hospital at 15 14
months of age because of an "urticarial-
like" rash and fever which had been pre-
sent for the previous 11 days. The rash had
begun over the neck and upper trunk and
finally spread over most of the body. Dilan-
tin was discontinued four days after the
rash developed. About three days before
admission her throat became red and she
began to cough frequently. The white cell
count then was 16,750, with 51 per cent
segmented forms and 47 per cent lympho-
cytes. She had retained little food. Her
bowel movements had become more fre-
quent and softer than usual, and she had
urinated only twice a day for the previous
three days. Her feet were swollen.

On admission the temperature was 101 F.,
pulse 110/min., respirations 20/min. and
the weight was 20 pounds. The skin was
covered with a partly confluent erythema-
tous macular rash, with beginning desqua-
mation in the diaper area. Axillary and in-
guinal lymph nodes were slightly enlarged.
The lungs were clear despite frequent
coughing. The liver had descended 5 cm.
below the right costal margin. The hands
and feet were moderately edematous. The
neurologic findings had not changed.

The hematocrit was 47 per cent, and the
leukocyte count was 45,250 mm3, with 48
per cent granulocytes, 25 per cent lympho-
cytes and 17 per cent monocytes. Many of
the monocytes and lymphocytes were atyp-
ical and questionably immature. A test (fer-
ric chloride) for phenylpyruvic acid in the
urine was negative. A trace of albumin was
present in the urine, with 10 to 15 leuko-
cytes and an occasional erythrocyte. A
growth of Escherichia coli was obtained
from the urine culture. X-ray films of the
skull were interpreted as showing micro-
crania.

272

NORTH CAROLINA MEDICAL JOURNAL

July, 1960

Hospital course

Hydrocortisone and intravenous fluids
were given and improvement occurred dur-
ing- the initial few days. After about two
weeks, however, the patient began having
up to 18 watery stools a day. The main
problem during the remainder of her life
was that of hydration and electrolyte bal-
ance. The dermatitis improved at times,
but eventually progressed to exfoliation,
with superimposed bullous eruptions. On
one occasion hemorrhagic vesicular lesions
were present on the hands, arms, feet, buc-
cal mucosa, and lips. Phenobarbital had
been discontinued on admission, but there
were no more seizures. In addition to ster-
oids and intravenous fluids, she was given
antibiotics and intravenous salt-poor albu-
min and blood. Despite all efforts and med-
ication, her condition slowly deteriorated.
During the three months' hospitalization
the blood urea nitrogen rose from 3 to 22
mg. per 100 ml., the hematocrit decreased
to 35 per cent, and the leukocyte count re-
verted to normal. Platelets were present on
all peripheral blood smears. Weight de-
creased to 12 pounds, although edema of
the extremities appeared to increase. The
total proteins were 5.4 Gm. per 100 ml.
with an albumin of 2.8 Gm. per 100 ml. On
the day before death pulmonary edema and
tachycardia developed and she became cy-
anotic about the lips. Following the admin-
istration of digoxin, morphine and oxygen,
some improvement was noted, but she died
shortly afterwards in apparent congestive
heart failure.

Autopsy findings

At autopsy the body was markedly ca-
chetic. Extensive areas of exfoliative der-
matitis were scattered over the trunk and
limbs; these were especially marked over
the scalp. The lesions were slightly de-
pressed and covered with a reddish-brown
crust. The epidermis was lost in many
fields and was replaced by a fibrinopurulent
exudate containing gram positive cocci. In
adjacent zones, vesicle formation and loss
of the normal epidermal pattern were pre-
sent. A chronic cellulitis was present in all
areas examined. Neither intranuclear nor
cytoplasmic inclusion bodies were present
in any section of skin.

Each pleural space contained 10 cc. of
serous fluid, but no adhesions. The lungs
were slightly heavy and remained distended

after removal from the cavity. The pleural
surfaces were normal. The cut surfaces of
the lungs were wet and exuded a slight
amount of frothy fluid on compression. A
generalized chronic interstitial pneumonia
with focal areas of atelectasis was present.
Scattered throughout the alveolar spaces
were large cells measuring 30 to 40 micra
in diameter (figs. 1, 2). They contained dis-
tinct oval or rounded nuclear inclusion
bodies which were about 10 micra in di-
ameter and surrounded by an optically
clear halo. The cytoplasm was eosinophilic
and contained irregular basophilic inclu-
sion bodies. The inclusion bodies stained
well with hematoxylin and eosin.

The heart and great vessels were normal.

The abdominal organs were grossly
normal but small for the patient's age. The
liver had a normal lobular pattern, but
contained many small foci of hematopoietic
cells. Intranuclear or cytoplasmic inclusion
bodies were not found.

The kidneys were normal grossly, but the
anatomic pattern was that of a newborn
infant : the glomerular tufts were com-
posed mainly of large cuboidal cells rather
than the flattened epithelium seen in nor-
mal infants of this age. The epithelial layer
of most capsules was composed of similar
cells. Many of the tubules were dilated, and
in some fields the epithelial cells were large
and contained intranuclear and cytoplasmic
inclusion bodies identical to those described
in the lungs (fig. 3). The inclusions were
less frequent than in the lungs and were
present mainly in the proximal tubular
cells.

Examination of tissue from the thyroid,
parathyroid, thymus, lymph nodes, skin, in-
testinal tract, bone marrow, adrenal glands,
pancreas and spleen failed to reveal cellu-
lar inclusion bodies. Permission for exam-
ination of the central nervous system was
not obtained. The salivary glands were not
removed because the nature of the disease
was not suspected at the time of autopsy.
Cultures for viruses were not made.

Comment
The most interesting feature of the pre-
sent case is that of the severe, unremitting
diarrhea. A correlation of diarrhea with
intestinal involvement is difficult, since
diarrhea has been reported both in the ab- ■
sence and presence of inclusion bodies'3'.
In some cases, moreover, typical nuclear in-

July, 1960

SALIVARY GLAND VIRUS DISEASE— GILBERT

272

»' • w5S-*4*J .•*/■'-■.- «->-.*. i*ss:v*-,'**v."l**.L « ._.* * " • • Ti v

Fig. 1. Photomicrograph of the lung demonstrat-
ing the large intra-alveolar cells containing nuclear
and cytoplasmic inclusion bodies. A marked inter-
stitial pneumonia is also present. (Hematoxylin and
Eosin lOOx)

Fig. 2. The nuclear and cytoplasmic inclusion
bodies characteristic of the disease are present in
the giant mononuclear cells in the alveolus.
(Hematoxylin and Eosin 400x)

inclusions were found in the gastrointestinal
cosa when diarrhea is absent. Though no
inclusions were found in the gastrointinal
tract, the diarrhea could have been a man-
ifestation of the generalized disease.

The dermatitis was thought to be a sen-
sitivity reaction to either Dilantin or phen-
obarbital and probably not related to the
salivary gland virus disease. In several re-
ported cases, however, a dermatitis has
been described (3>4) ; and in one, typical in-
clusion cells were present in the sweat
glands'5'.

Evidence of renal impairment was sug-
gested by an increasing blood urea nitro-
gen, and by slight amounts of albumin and
leukocytes in the urinary sediment. There
was no evidence of a bleeding tendency ex-
cept on the one occasion when hemorrhagic
vesicles developed over portions of the
body. The hepatomegaly was secondary to
congestion and foci of hematopoietic cells;
such foci are notable features in many
cases. The splenomegaly was secondary to
congestion only. Organs other than the

^* •

r<

i)

'• * vfc,,w

%

c-

?

9

Wk

i<Jj\

9%9

e

J*u%

• a:

° ■ * r e ^Lm a •

Fig. 3. Dilated proximal tubule of the kidney
containing large cells >vith nuclear and cytoplas-
mic inclusion bodies. (Hematoxylin and Eosin 600x)

274

NORTH CAROLINA MEDICAL JOURNAL

July, 19G0

lungs and kidneys did not contain typical
cellular inclusion bodies.

Correlation of the neurologic manifesta-
tions and the microcrania of the present
case with those of generalized salivary gland
virus disease cannot be made since the cen-
tral nervous system could not be examined.
In patients with this disease, however, the
brain sometimes shows typical cellular in-
clusions and anomalous developments, sug-
gesting that the neurologic disease in this
case may have been due to a malformation
related to the viral infection. Crome and
France"11 report one case associated with
microgyria and refer to other documented
cases with microgyria, hydrocephalus, peri-
ventricular calcification, focal softening
and hemorrhage, and other lesions. The
periventricular calcification has important
diagnostic implications and is discussed be-
low.

The factor or factors responsible for ac-
tivation of the apparently latent infection
in this child are not evident, as is true in
most instances of the post-neonatal group.
It is possible that the drug reaction low-
ered cellular resistance and allowed a dor-
mant, localized disease to become dissem-
inated. It is also possible, however, that all
signs and symptoms were related solely to
dissemination of the salivary gland virus.

Diagnosis

In most cases the disease is rarely diag-
nosed during- life. Hematologic studies are
nonspecific, commonly showing a moderate
lymphocytosis and slight immaturity of the
leukocytes A normocytic anemia and
thrombocytopenia occur in many neonatal
cases. With renal involvement there may be
a rise in blood urea nitrogen; albumin and
leukocytes may be present in the urine.
Liver function tests may detect parenchym-
al cell damage. All of these abnormalities
are nonspecific.

The most specific means of diagnosis at
the present is the demonstration by cyto-
logic examination of inclusion-bearing cells.
The typical cells may be found in the urine,
bronchial secretions, or gastric washings.
The kidneys are commonly involved in both
the neonatal and post-neonatal phase, and
the most rapid, simplest, and cheapest means
of establishing a positive diagnosis in these
age groups is by cytologic examination of

the urinary sediment. In some post-neona-
tal cases and in adult cases, examination of
sputum or gastric washings may establish
the diagnosis, since patients in these groups
frequently have pulmonary involvement.
Details of collection and preparation of
specimens are given in the excellent review
by Nelson and Wyatt171. With central nerv-
ous system involvement, these cytologic
methods applied to the cerebrospinal fluid
may establish a diagnosis' Sl. Biopsy ma-
terials from the liver, lungs, and kidneys
have contained the typical inclusion bear-
ing cells in routine paraffin sections.

Radiologic diagnosis is dependent on the
presence of periventricular calcifications
which outline the lateral ventricles'8'. Re-
covery of the virus by cultural methods has
been successful11", but at present only a
few centers have the equipment necessary
for this technique.

Treatment

There is no specific treatment. Antibio-
tics, steroids, gamma globulins, and blood
have been employed, but, in most cases,
with disappointing results. It is not known
whether gamma globulins and blood con-
tain effective antibodies to the virus, but
Rowe and others'1"' demonstrated comple-
ment-fixing antibodies in 53 per cent of un-
selected persons between 18 and 25 years of
age and in 81 per cent of persons over the
age of 35 years. In a group of newborn in-
fants, 71 per cent had antibodies, whereas
in the age group of 6 months to 2 years
only 14 per cent had demonstrable anti-
bodies. It has been suggested that pro-
longed steroid and antibiotic therapy may
further weaken the host's defense against
the disease.

Summary

A case of generalized salivary gland
virus disease occurring in the post-neonatal
period is presented. A brief discussion of
the important features in the neonatal,
post-neonatal and adult forms of the disease
is included. Recently developed means of
making an antemortem diagnosis are dis-
cussed. The value of cytologic examination
of urine, sputum, or gastric washings in
making such diagnoses is emphasized.

References

1. (a> Symmers, W. S. C: Generalized Cytomegalic In-
clusion-body Disease Associated ■with Pneumocystis Pneu-

July, 19(30

SALIVARY GLAND VIRUS DISEASE— GILBERT

275

monia in Adults, J. Clin. Path. 13:1-21 (Jan.) 1960. (b)
Capers, T. H. and Lee, D. : Pulmonary Cytomegalic In-
clusion Disease in an Adult. Am. J. Clin. Path. 33:238-
242 (March) 1960.

Wyatt, J. P.. Saxton, J.. Lee. R. S., and Pinkerton, H.:
Generalized Cytomegalic Inclusion Disease, J. Pe lint.
36:271-294 (March) 1950.

Allen, J. H.. and Riley, H. D., .lr.: Generalized Cyto-
megalic Inclusion Disease, with Emphasis on Roentgen
Diagnosis, Radiology 71:287-262 (Aug.) 1958.

Medearis, D. N., Jr.: Cytomegalic Inclusion Disease; An
Analysis of the Clinical Features Based on the Literature
and 6 Additional Cases. Pediatrics 19:467-480 (March)
1957.

6. Worth, W.

and Howard, H. L. : New Features of In-

clusinn Disease of Infancy. Am. J. Path. 26:17-35 (Jan.)
1950.

6. Crome, L. and France. N. E. : Microgyria and Cytomega-
lic Inclusion Disease in Infancy, J. Clin. Path. 12:427-
434 (Sept.) 1959.

7. Nelson, J. E., and Wyatt, J. P.: Salivary Gland Virus
Disease, Medicine 38:223-241 (Sept.) 1959.

8. McElfresh, A. E., and Arey, J. B.: Generalized Cyto-
megalic Inclusion Disease, J. Pediat. 51:146-156 (Aug.)
1957.

9. Kluge, R. Cm Wicksman, R. S., and Weller. T. H.: Cy-
tomegalic Inclusion Disease of the Newborn, Pediatrics
25:35-39 (Jan.) 1960.

10. Rowe, W. P., and others: Cytopathogenic Agent Resem-
bling Human Salivary Gland Virus Recovered from Tissue
Cultures on Human Adenoids, Proc. Soc. Exper. Biol.
& Med. 92:418-424 (June) 1956.

Antibiotic Resistant
Pulmonary Staphylococcic Infections

Captain George L. Calvy, MC, USN*
Camp Lejeune

Staphylococcic infections have been a
challenging problem for many years. Be-
cause of the wide distribution of staphylo-
cocci in the environment and on human
body surfaces, the problem will probably
remain for a long time.

Impressive evidence of penicillin's bac-
tericidal potency was available soon after
its introduction. Strains of bacteria grad-
ually emerged, however, that exhibited re-
sistance to this antibiotic. This was par-
ticularly evident in the case of Staphylococ-
cus aureus. Additional antibacterial agents
were introduced only to lose much of their
effectiveness as increasing numbers of these
antibiotic-resistant strains appeared. The
following outline lists known biologic char-
acteristics of the staphylococcus which help
explain its formidable nature.
1. Toxins and Lysins

a. Exotoxin (lethal toxin; potent; when elab-
orated in vivo, its lethal effect appears to
be delayed until a critical threshold dose
has accumulated; associated with necrotic
and hemolytic reactions in a majority of
toxigenic strains of Staph, aureus.)

b. Enterotoxin (potent toxin acting primarily
upon the gastrointestinal tract)

c. Dermonecrotic toxin (necrotizing toxin;
hemolysin ? ) alpha, 2

d. Hemolysin (alpha, beta, gamma, delta; rbc
lysins)

Read before the Second General Session, Medical Society of
the State of North Carolina, Raleigh, May 11, 1960.

*Commanding Officer, Naval Field Research Laboratory,
Camp Lejeune, North Carolina.

e. Fibrinolysin (dissolves fibrin clots; re-
stricted essentially to coagulase-positive
human strains)

f. Leucocidin (destroys leucocytes)
2. Enzymes

a. Coagulase — regarded as the sine qua non
for pathogenicity (coagulates citrated or
oxalated plasma); also neutralizes the anti-
bacterial activity of normal human serum
for staphylococci).

b. Hyaluronidase (attacks the mucopolysac-
charide — hyaluronic acid — intracellular
ground substance; "spreading factor")

c. Staphylokinase (plasminogen activator)

(fibrinolysin? )

d. Penicillinase. This is a notorious substance
responsible for treatment failures (inac-
tivates penicillin)

e. Gelatinase

f. Proteinase

g. Lipase

Note: Pathogenic human (often of hospital ori-
gin), coagulase-positive staphylococci frequently
belong to general phage group III, types 80/81.
These strains can now be further identified by
fluorescent antibody staining techniques.

Hospital Experience

An experience in a large general hospital
points up facets of the problem'11. During
a two-year period more than 40 cases of
antibiotic-resistant staphylococcic pneumon-
ia, principally due to a hospital-acquired
strain, were diagnosed and treated. This
hospital contained a large segment of long-
term patients, and staphylococcic pneu-
monia first appeared as a complication of

276

NORTH CAROLINA MEDICAL JOURNAL

July. 191.0

pre-existing- major diseases such as car-
cinoma, lymphoma, and urologic disorders.
In later instances, staphylococcic infection
occurred postoperatively in more newly ar-
rived patients, and suspicion was directed
toward staff personnel, both medical and
surgical, as well as nursing attendants,
who might be carrying pathogenic strains
and/ or hidden lesions (furuncles, boils,
and so forth). Screening measures were in-
stituted to identify these carriers and to
limit the assignment and movement of such
personnel. Finally, a sharp upsurge in in-
cidence of staphylococcic infections oc-
curred at the height of the Asian influenza
epidemic in the fall of 1957. In addition to
patients who acquired infections in hospi-
tal, 1 medical officer, 1 nurse and 5 hospital
corpsmen fell victim to staphylococcic
pneumonia, emphasizing the communicable
aspects of this disease problem.

At the beginning of the Asian influenza
epidemic, a significant number of known
staphylococcic infections was present in the
hospital.

Cose 1

The urgent and widespread character of this
problem had previously been recognized when one
of our young staff hospital men was stricken. He
had suffered from a cold and had resorted to self-
medication with several different antibiotics during
a three-week period. During this time his fiancee,
a hospital WAVE, was hospitalized for furuncu-
losis, and he had also attended a patient with se-
vere staphylococcic pneumonia. Shortly thereafter
he was admitted to the sick list with pleuritic pain
and signs of pneumonia. A chest roentgenogram on
the morning he was admitted was interpreted as be-
ing essentially negative. By afternoon extensive
infiltration was demonstrable in the right base,
and by the following morning radiographic find-
ings revealed areas of consolidation and infiltra-
tion involving the entire right lung with extensive
involvement of the left lung. A positive blood cul-
ture yielded coagulase positive Staphylococcus
aureus, phage type 52-42B-80, 81, the so-called
"hospital strain." Despite heroic measures he died
on the third hospital day.

This shocking case served to provoke the
action outlined in table 1.

The Pneumonia Team consisted of four
medical officers who stood a telephone
watch and were available as consultants
around the clock. Whenever a patient sus-
pected of having pneumonia was admitted,
the medical officer got in touch with a mem-
ber of the team and discussed the general

Table 1

Task Force Staphylococcus

January 15, 1957

I. Antibiotic Control Board — chloramphenicol.

novobiocin and ristocetin reserved for severe
infection

II. Pneumonia team (telephone watch)
III. Epidemiology center

1. Epidemiology officer

2. Sanitation technician

3. Bacteriologist

4. Representative from Medicine, Surgery,
Genitourinary, Laboratory, and Nursing
services.

problem, the bacteriologic study of the spu-
tum, and the radiologic changes. In this
manner a constantly high level of clinical
awareness of staphylococcic pneumonia was
maintained. The theme of this operation
was "do it yourself," for the admitting doc-
tor collected and examined the sputum, in-
terpreted his patient's x-ray films, and
sought consultation at the earliest oppor-
tunity. Diagnosis was made earlier and
treatment was standardized ; tracheostomy
was performed in 21 cases, both as a pre-
cautionary and as an emergency procedure.
These factors are believed to have contri-
buted significantly to curbing the mortal-
ity rate in this series.

Hemolytic, coagulase-positive staphylo-
coccic pneumonia may present as a ful-
minant process terminating in death be-
fore bacteriologic proof can be obtained. In
such instances as case 1, large doses of in-
travenous bactericidal antibiotics should be
given while awaiting bacteriologic confir-
mation. The following case highlights the
multiple complications and therapeutic frus-
trations that may attend a fulminant dis-
seminated infection.

Case 2

A 21 year old white man was referred to the
Medical Service because of pneumonia, etiology
undetermined1-1. The history revealed that he had
sustained a fracture of the second cervical verte-
bra in an automobile accident. Treatment had con-
sisted of "prophylactic penicillin and streptomy-
cin" and tong traction. While he was receiving
these antibiotics, a secondary infection of the
scalp became evident. Generalized urticaria de-
veloped, and penicillin was stopped. Two days
later a fever of 106 F. and a nonproductive cough
developed. The patient was then started on terra-
mycin, 500 mg. given intravenously twice daily,
with no effect. A roentgenogram of the chest re-
vealed pneumonia in the right upper lobe. Intra-

July, 1960

PULMONARY STAPH INFECTIONS— CALVY

277

venous terramycin was continued for two days,
during which time his condition deteriorated rap-
idly. When received on the Medical Service he was
semicomatose and cyanotic.

A tracheostomy was performed and the aspirate
cultured out hemolytic Staph, aureus, coagulase-
positive. A culture of the scalp infection and
blood cultures revealed the same organism. Chlor-
amphenicol, 500 mg. given orally every four hours,
was started (before the culture reports were ob-
tained). During this time his condition worsened,
with the rapid appearance of left ventricular fail-
ure and cyanosis. Intravenous sulfadiazine, 3.75
Gm. every 12 hours, was started; rapid digitaliza-
tion and phlebotomy were performed, and respir-
atory support was maintained by a Drinker res-
pirator. During the next three days the temper-
ature dropped by lysis, and objective improvement
was evident; however, on the fourth day, semi-
coma recurred.

Sensitivity studies on the material previously
obtained for culture revealed in vitro sensitivity
to Aureomycin, bacitracin, chloramphenicol, ery-
thromycin, nitrofurantoin, neomycin, tetracycline,
hydrochloride, and novobiocin. In vitro resistance
was found to dihydrostreptomycin, penicillin, poly-
myxin B, terramycin, and sulfadiazine. Erythro-
mycin, 200 mg. given every four hours intramus-
cularly, and Aureomycin, 500 mg. every six houis
by nasogastric tube, were administered, resulting in
a drop of temperature to 102 to 103 F., where it
remained. Under this regimen, however, the pneu-
monic process extended to involve the entire right
lung and the left upper lobe.

On the fifth day of this phase of the regimen, the
patient had a right spontaneous pneumothorax,
with resulting pyothorax and open bronchopleural
fistula. Subsequent antibiotics and chemical agents
consisted of combinations of novobiocin, sulfadia-
zine, erythromycin, and streptomycin, during
which time the patient developed a persistent
tachycardia of 150, pericardial friction rub, electro-
cardiographic evidence of pericarditis, fixed spe-
cific gravity of urine, and continuous albuminuria.
Fever continued between 102 and 104 F., and the
spleen became palpable. A full-blown septicemia
was evident at this time.

All values remained static until ristocetin, 1000
mg. initially and 250 mg. every six hours, was
started intravenously, in combination with the
previously mentioned antibiotics. Ristocetin was
continued with a gradual tapering in dosage for
12 days, at which time fever dropped by lysis.
Evidence of pericarditis disappeared, the spleen
was no longer palpable, blood cultures became
negative, dissemination of the pneumonic process
appeared to be arrested, with localization of em-
pyema pockets amenable to thoracentesis and
closure of the bronchopleural fistula. Rapid sub-
jective and objective improvement of the patient
ensued. Intravenous ristocetin was discontinued
after 12 days, and the patient was maintained on

oral novobiocin, 500 mg. every six hours, for the
next two months.

This case demonstrates the gravity of a
hospital-acquired staphylococcic pneumonia
and its complications. Eighteen combina-
tions of 10 different antibiotics and sulfa-
diazine were used with- no apparent re-
sponse except for transient response to sul-
fadiazine, to which resistance quickly oc-
curred. Erythromycin and novobiocin were
ineffective; however, when ristocetin was
added, clinical improvement was noted.
This man was discharged fully recovered,
and is carrying on at full activity.

Radiologic characteristics

Early in this experience it became evi-
dent that there were radiologic character-
istics peculiar to staphylococcic pneumonia,
of high reliability in leading to diagnosis.
Radiologic Findings
Rapid Progression — in hours
I. Early — small patches of consolidation
II. Infiltration c circumscribed translucencies

III. Pleural effusion

IV. Typical — pneumatoceles

V. Spontaneous tension pneumothorax c or s
empyema

Analysis of antibiotic sensitivities re-
vealed most of the encountered organisms
in our series to be resistant to the sulfona-
mides, tetracyclines, streptomycin, and pen-
icillin.

Erythromycin, which enjoyed great pop-
ularity in the surrounding community,
was ineffective in dealing with our severe
staphylococcic infections. The best thera-
peutic results were obtained with chloram-
phenicol and intravenously administered
ristocetin. Vigorous supportive therapy in-
cluded tracheostomy. Gamma globulin was
administered to 16 patients as adjunctive
therapy.

An excellent report by Ede, Davis, and
Holmes emphasized early surgical therapy
for complications'"''. Pulmonary complica-
tions encountered in our experience were
pneumothorax, empyema, lung abscess, and
tension cysts. Only 2 patients had signifi-
cant respiratory disability after recovery.

Comment

A recent editorial in the Neiv England
Journal of Medicine pointed out the critical
role that combinations of antibiotics may
have played in bringing about the present
state of affairs'41. The most popular and at
the same time most dangerous of the anti-

278

NORTH CAROLINA MEDICAL JOURNAL

July. 1960

biotic combinations is that of penicillin and
streptomycin, employed to treat many cases
when streptomycin is almost always redun-
dant. Unfortunately, it also is used for the
prophylaxis of infections which it rarely
prevents. Instead, it has contributed to the
occurrence and increased severity of anti-
biotic-resistant infections and serious toxic
effects. A large number of new combina-
tions has been introduced. Since none of the
combinations has clearly shown any thera-
peutic advantage over the proper use of the
more effective component alone, the patient
is unnecessarily placed in "double jeopar-
dy"— of toxic reactions and of acquiring
sensitization to both agents.

Berntsen and McDermott'"" observed
that the carrier rate among hospitalized
patients receiving tetracyclines increased
nearly threefold over the rate among hos-
pitalized patients receiving no antibiotics.
In addition, new strains were substituted
for old among antibiotic treated patients at
twice the rate observed in untreated pa-
tients.

On the basis of substantial evidence sug-
gesting that multiple-resistant strains of
Staph, aureus, hospital variety, are of en-
hanced virulence, Barber and her colleagues
at Hammersmith Hospital in London made
a vigorous attempt to cut down the inci-
dence of infection by these organisms16'.
This effort was combined with strict appli-
cation of various anti-cross-infection mea-
sures that had been previously introduced,
and featured : ( 1 ) marked restriction of
the use of all antibiotics for prophylactic
purposes; (2) strict limitation of the use
of penicillin; (3) the general employment
of double chemotherapy, each drug being
used in full doses and only for definite in-
dications. Under this policy a significant
reduction of antibiotic-resistant infections
occurred and concomitantly the number of
infections sensitive to penicillin rose sharp-
ly.

It may be pointed out that agents like
Kanamycin, vancomycin and ristocetin
have had little tendency to produce resist-

ance. Such resistance is difficult to produce
in vitro. These antibiotics are given intra-
venously, a limiting factor in their whole-
sale use.

Co)iclusion

In general, when dealing with severe
staphylococcic infections, a focus on target
with a narrow spectrum antibiotic may
bring best results. Success with ristocetin
and vancomycin has been attributed to this
factor.

Awareness of the manifestations and
gravity of staphylococcic pneumonia, with
attention to early diagnosis and decisive
therapy, both medical and surgical, is to be
emphasized as essential for the successful
management of this disease.

Measures to lessen the incidence of staph-
ylococcic infections have been effective
when they have emphasized a return to
principles of rigid asepsis, isolation of in-
fected patients and judicious control and
use of antibacterial agents. Recognition of
the fact that the use of steroids and anti- I
biotics may actually encourage invasion by
staphylococci is essential. Observance of
the foregoing measures may then go far
toward suppressing, if not eradicating,
these infections.

References

1. Calvy, G. L.: Stalking the Staphylococcus: New England H
J. Med. 259:532-534 ( Sept. I 11) 1958.

2. Schumacher. L. R.. Coates. J. R., Sowell, R. C. and
Calvy, G. L.: Staphylococcal Pneumonia: A Clinical
Evaluation of 40 Cases. Clin. Research 7:267 (April) 1959.

3. Ede. S.. Davis. G. M.. and Holmes. F. H.: Staphylococcic
Pneumonia. J.A.M.A. 170:638-643 lJune 6) 1969.

4. Editorial: Antibiotics in Fixed Combinations. New Eng-
land J. Med. 262:255-256 I Feb. 4 1 1960.

5. Berntsen, C A., and McDermott. W.: Increased Trans-
missibility of Staphylococci to Patients Receiving an
Antimicrobial Drue. New England J. Med. 262:637-642
(March 31) 1960.

6. Barber, M.. and others: Reversal of Antibiotic Resistance
in Hospital Staphylococcal Infections, Brit. M. J. 1:11-17
(Jan.) 1960.

July, 1960

279

Some Facts About Nursing in North Carolina

Vivian M. Culver, R.N.
Raleigh

May I thank the program committee for
the invitation to appear before this assem-
bly today. I consider it a real privilege and
an opportunity to share with you some in-
formation regarding nursing and nursing
education in this state.

What I have to say about North Caro-
lina's needs in nursing is not unique to this
state, but this fact does not make our needs
any more palatable. And what I have to say
in relation to shortages of prepared people
is not peculiar to nursing alone. We are
experiencing a real lag in the preparation
and retention of members in your group, in
my group, and in other paramedical groups
as well. You are as aware of these facts as
I.

In looking closely at nursing in North
Carolina, I could quote all types of figures
for you. But the fact remains that we are
short of two things — nurses and nursing.

The Shortage of Nurses

Why are we short of nurses? Here are
five principal reasons for this situation.

1. We do not recruit enough capable
young women — and men, too — into this
field. Other areas of endeavor are earnestly
competing for high school graduates.

2. Out of the number we do recruit, the
quality of the candidates yields about a 35
to 40 per cent drop-out — not in all cases for
scholastic reasons, but in the majority. Too
many students can't read, write, and think
productively. The course in nursing is
rugged. And high school has never given
them so much to do in so short a time.

3. Then after completing the course, any-
where from 25 to 35 per cent fail one or
more of the five subjects in the licensure
examination.

4. Then after licensure we are constantly
losing from two to three nurses to other
states for every nurse who come here to
work.

5. And finally, no small factor in this
problem is the number of nurses who are
inactive in the profession. After a number

Read before the Second General Session, Medical Society
of the State of North Carolina, Raleigh, May 11, 1960.

•Executive Secretary, North Carolina Board of Nurse Regis-
tration and Nurse Education.

of child-rearing years a large percentage
come back. But presently there are over
5,000 inactive nurses in North Carolina.

I have enumerated five serious problems
in relation to the short supply of nurses.
There are others quite familiar to all of us.

The Shortage of Nursing

Next, let's look at the shortage of nurs-
ing. Quite naturally a limited number of
nurses yields less nursing. But that isn't
the only limiting factor.

Nursing is perhaps best described as the
giving of direct assistance to a person, as
required, because of the person's specific in-
ability to care for himself for reasons of
health11'. Self-care means the care which
all persons require each day, and you well
know what modifications are necessary dur-
ing illness.

Added responsibilities

Our horizons in health care and medical
management have expanded more in the
last 25 to 30 years than in all previous his-
tory combined. This lays tremendous re-
sponsibility on your shoulders, not only in
cure but in prevention and rehabilitation as
well. The new techniques, methods, equip-
ment, drugs, and treatments for that 30-
year period would defy enumeration by
anyone in this room today. You have asked
my group to help carry some parts of your
expanding responsibilities. We have tried —
we are trying. Every task that you no
longer have the time to do or that you feel
is safe for one with less depth of medical
understanding you quite naturally ask the
nurse to do. Just two examples — very ele-
mentary, yet significant: Within 60 years
the thermometer has moved from the red
plush box in your bag to every home and
hospital. And in the last 30 years the
sphygmomanometer has come to be used
even by the practical nurse.

Today we are struggling with the task
of starting intravenous fluids — and trying
to determine what safe steps can be taken
to ensure better care of the "about to de-
liver" mother — among a host of other shift-
ing responsibilities.

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NORTH CAROLINA MEDICAL JOURNAL

July, I960

Why do I mention shifting of some re-
sponsibilities? First, because it is a natural
development to a point; and next, because
the greater the demands on the nurse to
support the doctor in his plan of medical
management, the less time she has to meet
the needs of the patient which have no
doctor's orders written for them.

Complexity of organization

Another factor in the shortage of nurs-
ing is the highly complex organization of
today's hospitals. Much nursing time is
consumed in the mechanics of this organ-
ized structure. Some say it is so highly
structured that it is impersonal — and this
fact is poorly understood by a sophisticated
society.

What happens to the person — the nurse
who by the very elements of her employ-
ment no longer has time to assist the pa-
tient? In due time she is apt to be satisfied
in managing, scheduling, ordering, and do-
ing the highly technical things falling to
her professional lot. If not, she is frus-
trated, resigns, and tries to find some place
where she can get back to the patient's side.
Then she is accused by management of not
wanting to take responsibility. I ask you —
responsibility for what? The patient, yes,
but management and direction of others,
no. Many nurses do not want to be man-
agers of nurses; they want to take care of
patients. Our present structure inhibits this
desire.

No one factor is responsible for the
shortage of nursing, as you can see. Many
things are at work to bankrupt professional-
ly the bedside nurse today. If there ever
was a time when hospital administrators,
doctors and nurses needed to look critically
at how patients are getting hospital, med-
ical, and nursing care, it was yesterday.
This joint action is long overdue.

Inadequacies in Nursing Education

Nursing education in North Carolina is
almost low man on the totem pole in this
country. We have schools — we're eighth in
the country in number. We have students —
we're thirteenth in the country with them.
T}|it Ayppn we put our graduates against
graduates from other states on our licen-
sing examination, we are well tnwarH t-Tjp
bcfttenrr^l have sonle1 -oplllloiis" as to why
this is happening — some based upon fact
1 and others upon feeling. Many of you have

opinions too — likewise based upon fact and
feeling.

Quality of teaching

One opinion I have is that the quality of
teaching is below par. Why do I think so?
Because 31 per cent of our teachers are not
trained beyond their three-year diploma
programs. They are not prepared as teach-
ers. Teaching is itself a specialized art.

I am not talking here about those few
unique individuals among the 31 per cent
who are naturals in the teaching role. I am
concerned that too many of the remaining
souls in that group are not giving the stu-
dent a fair chance to learn nursing. It could
and should be said that merely having a de-
gree does not ensure that fair chance to
learn, either. But if additional preparation
means anything, it should provide a
broader, deeper insight into the content to
be taught, and effective ways to get it
across.

Along with our lag in preparation for
teaching, we are short in numbers of
teachers. As of March 30, 1960, 14.6 per
cent of the teaching positions in diploma
schools were unfilled. And the prospect is
worse for fall. We do not have the teachers.
These things I know to be facts.

Content of teaching

Now I have a feeling that part of our
difficulty in our programs is what I call
curriculum obesity and patient-practice
starvation. When people in charge of
schools do not know how to design and im-
plement a curriculum, there is a great urge
to add first one course and then another,
thus thinking that they are keeping the pro-
gram up to date. This is where the obesity
sets in, and for every unneeded hour added
to the classroom schedule we deny the stu-
dent the opportunity of that hour to put into
action some of her learning. What has hap-
pened is that there is less and less time to
teach and learn the art of meeting the needs
of patients.

In this process of addition we have not
carefully scrutinized what we teach, nor
have we done a good job of distilling those
elements which have always been and will
continue to be the essence of effective nurs-
ing. We are trying — but it takes a qualified
person to lead the faculty to such action.
When such a person is lacking, a school
rocks along, not knowing how to tighten up

I

I

July, 1960

NURSING IN NORTH CAROLINA— CULVER

281

the curriculum and put back into nursing
those elements that have been crowded out.
iWise choices must be made in selecting con-
tent. If the essence of nursing has been re-
placed with what appears to be more im-
portant content, the faculty has some im-
portant decisions to make.

We need to help the student to learn to
think through nursing situations— to draw
I on her knowledge and develop judgment in
carrying out her designated ministrations.
Too often we fill the student with facts and
then siphon them off in a test. Until these
facts are put to practical use — until they
are understood and translated into nursing
care action — are they learned?

I honestly believe that this is one impor-
tant and significant reason why we have so
many State Board failures. The questions
are just not that difficult. They are thought-
provoking — yes. They are situational — yes ;
they draw upon knowledge — yes; and they
ask for designated action, judgment, read-
ing ability, familiarity with vocabulary,
and reasoning ability.

We have recently visited a state in the
deep South to try to determine why their
graduates pass State Boards and ours fare
so poorly. One finding was that every school
has some prepared faculty. They make it
their business to teach less medicine and
more nursing. They locus on trie p'allfelll 111
their teaching and in the student's practice.
' This we are beginning to do, too, but we are
having a hard time shaking loose from the
idea that the focus should not be on the dis-
ease but on how to nurse the patient who
has specific needs because he has a certain
disease or deficiency.

Need for a Joint Approach

I will never have a better opportunity to
thank you ladies and gentlemen for your
continuing efforts and interest in nursing
education in this state. We appreciate and

need your contributions. We also need your
continued understanding to help us with
our boot strap operation.

I would like to see North Carolina lead
the nation in a joint study of this serious
problem of shortage of nurses and nursing.
I would like to see medicine, hospital ad-
ministration, and nursing attack the prob-
lem together. In some states the medical
group appoints a committee, makes a study,
and comes out with a report. Hospital ad-
ministration agonizes over it and from time
to time tries to solve the whole thing at a
convention. This problem is much too com-
plex for such atomistic attacks. It is serious
enough to tax the combined effort of all
concerned. North Carolina could make such
an approach, and by so doing could set an
example of the leadership so woefully
needed today in arriving at solutions.

We had some joint action in North Car-
olina during the Good Health movement.
The nation watched North Carolina at that
time with great interest. A report was pub-
lished in 1950 concerning our needs in
nursing. We have not done much during
this decade to come really to grips with
those recommendations or to know whether
they were realistic or attainable. Many of
the recommendations are still unmet — and,
I might say, unknown and forgotten.

We must come to grips with what is
realistic for us to do in North Carolina and
what is unattainable. To do this we need
facts — more facts with less emotionalism
and I might even add less provincialism.
This is a serious challenge. Until we meet
it, hospital administrators, doctors, and
nurses will continue to talk about this prob-
lem in misty generalities.

Reference

1. Orem, D. E. : Guides for Developing Curricula for the
Education of Practical Nurses. Washington. D.C., U. S.
Department of Health. Education and Welfare, 1959.

... it is necessary that both in schools and in universities we should
rediscover the part played by leisure in education. There is a danger that
we may so fill our pupils' lives, not only with specialist studies, not only
with the process of overfrequent examining, but with general education
and social activities as well, that they may never have time to read or
talk or even simply to think what it is all about. — Sir Eric James, Brit.
M.J. 2:576 (Sept. 6) 1958.

L'SL'

NORTH CAROLINA MEDICAL JOURNAL

July, 1960

A Rural Home Care Program

O. David Garvin, M.D., M.P.H.
Chapel Hill

To tell you about the Rural Home Care
Program now being carried on in Person
County, North Carolina, I must tell you a
little about the county. Person County is
one of five counties making up the district
of which I am director. It is located in the
north central portion of the state and
covers an area of 20 miles square, with one
town, Roxboro — population 5,000. The total
population of the county is 25,000 of whom
about 40 per cent is non-white. It is one of
the few counties that experienced a popu-
lation loss between 1940 and 1950. This
loss was attributed to the migration of able-
bodied persons in search of work. These
migrants leave their children behind in the
care of grandparents, creating many prob-
lems and difficult financial situations.

Person County is primarily rural, deriv-
ing its income chiefly from farm products
(tobacco), with a few small manufacturing
companies located around the town of Rox-
boro.

Person County has 11 practicing physi-
cians— one retired for all practical pur-
poses, two surgeons, one internist, and
seven general practitioners, two of these
being over 70 years of age. There is a good
60-bed general hospital (constructed with
Hill-Burton funds). The Health Depart-
ment is housed in a new building. Within
50 miles of Roxboro are four large medical
centers. The working relationship within
the county has been cooperative and har-
monious.

Tuberculosis Program Paves the Way
When I came to Person County in 1944, I
found a minimal tuberculosis program di-
rected toward the far advanced cases be-
cause of limited facilities and personnel. At
that time, tuberculosis and venereal disease
were the most pressing health problems in
the county. As a result of improved medica-
tion, refined diagnosis and techniques in
health education, the venereal disease prob-
lem has been brought under control. We
have worked just as diligently on our tu-
berculosis problem, with the result that
our death rate from tuberculosis is virtual-

Read before the Regional Conference on Aging, Atlanta,
Georgia, March 7, I960.

ly nil, while our case rate increases and our
total number of cases under supervision
multiplies. Last year our county had one of
the highest case rates in the state.

I emphasize the role of tuberculosis in
our set-up because of its direct bearing on
the present Home Care Program. Fifteen
years ago when it became evident that
many of our tuberculous patients were dy-
ing at home while awaiting sanatorium ad-
mission, a program of home care was a
pressing necessity. At the suggestion of the
County Medical Society, the County Board
of Commissioners provided extra funds for
hospitalization, employment of additional
public health nurses, and purchase of equip-
ment for the home care of the tuberculous.
In this program, the Health Department
played the major role by furnishing the
x-ray facilities for screening, diagnosis,
and follow-up, and I provided medical care
within the home for patients who were
under the supervision of the local doctors.

This program was agreed on and devel-
oped jointly by the Health Department,
Medical Society, County Board of Commis-
sioners, and other agencies both voluntary
and official. At this particular time no
young doctors were practicing within the
county, and it was the wish of the local
medical society that I provide the tubercu-
losis treatment while they supervised the
case and treated any complications or acute
illnesses that occured. Later, the County
Board of Commissioners provided funds
for drug therapy for tuberculosis cases.

As a result of the successful handling of
the tuberculosis problem in the county and
the harmonious cooperation of everyone
concerned, it was no problem to secure sup-
port for the expanded Home Care Program.
In addition to our Tuberculosis Program,
we were confronted with an aging popula-
tion afflicted with so-called "chronic dis-
ease." Throughout all these years of work,
publicity was given the work being done
and the needs existing within the county.
All media were used to inform the county
officials and the public of the needs of the
county.

July, 1960

RURAL HOME CARE— GARVIN

283

Project Proposal Approved

Several years ago the local, State and
American Medical Associations, the local,
State and National Public Health agencies,
and officials at all levels of government be-
gan to realize that a program for Home
Care should be developed, and that it
should not be restricted to urban areas but
made available to all people. Until we un-
dertook to provide home care in this rural
area, no similar project had been developed.
When it was suggested that support from
official agencies, the Public Health Service,
and the State Board of Health could be
secured if the county would provide some
funds for matching purposes, it was not
difficult to secure the local support needed.

In cooperation with the Person County
Medical Society, the State Board of Health,
and the U. S. Public Health Service, a pro-
ject proposal was prepared and submitted.
After the State Board of Health and the
Public Health Service gave tentative ap-
proval, the County Commissioners appro-
priated a sum of money for matching pur-
poses. Final approval was given the project
and the following personnel were author-
ized : a medical social worker, physical
therapist, two public nurses, and one clerk.
Also, funds for contractural purposes were
made available.

The tentative project proposal was not
prepared or submitted until it had been
discussed in detail with the local medical
society, and a set of policy and procedure
statements relating to every phase of the
anticipated program had been developed.
The local society agreed, without a single
dissenting voice, to provide medical care
and supervision for all persons residing
within the county who were referred to and
carried by the project. The purpose or ob-
jectives are "To show how National, State
and Local agencies, both official and non-
official, can coordinate their efforts in a
program for Home Care and restoration of
the chronically ill in a rural area and to de-
termine what personnel and funds are ne-
cessary to provide for services aimed at
self care or self support by the patients."

At this time, it was agreed that the
doctor-patient relationship would remain in
effect at all times ; that the project would
not accept patients referred by anyone
other than the physician. The physician
would continue to direct the care of the pa-

tient at all times, the Health Department
would provide services available through
the staff, and no fee would be charged for
services rendered by the staff of the Health
Department. After the endorsement by the
local medical society, the project proposal
was submitted through official channels.
Operation began officially when the phy-
sical therapist reported for duty. The pro-
ject is now operating with a full staff of
qualified workers.

Home-Care Integrated into Total
Health Program

We have endeavored to integrate this
program into the over-all program of the
Health Department and of the many other
agencies providing health services in the
community. The services available through
the project are nursing, physical therapy,
social service, occupational therapy, nutri-
tional counseling, medicine and sick room
supplies, orthopedic equipment, and health
education. Every other community resource
is brought to bear upon the patient's illness
through the coordination of the Health De-
partment. Lay committees organized dur-
ing the planning stage are Health Educa-
tion, Procurement and Supply, Vocational
Rehabilitation, Social Service, and Chap-
lain and Recreation. In addition, there is
an advisory and technical committee made
up of representatives from local and State
medical societies, local and state welfare
associations, State Nurses' Association,
State Board of Health, and the University
of North Carolina School of Public Health.

All benefits to the individual patient in
the program are the result of a concerted
"team effort." The Health Department
team teaches and provides services as
ordered by the attending physician. The
patient and his family are taught the pro-
per care of the patient through the actual
services of the physical therapist, the Pub-
lic Health nurse, the medical social worker,
and the nutritionist. Thus the private phy-
sician and this team work as an effective
unit toward the achievement of maximum
recovery and physical independence of the
patient.

I spent much of the time alloted me in
discussing the history of the Person Coun-
ty Home Care Demonstration Project and
the needs that brought it into being. This
project was a natural outgrowth of com-
munity recognition and interest. In fact,

284

NORTH CAROLINA MEDICAL JOURNAL

July, 1960

the medical society, county officials, and the
public at large have cooperated in a man-
ner that has been heartwarming to those of
us who so often have seen this segment of
our population cast into the role of the for-
gotten man. This is a type of program that
can be developed and operated in any rural
area where there are an informed public,
medical facilities, and an agency that can
serve as coordinating agent.

I want to restate the purpose of the pro-
ject, "To demonstrate how Federal, State,
and Local Official and non-official agencies
in the community as individuals and as a
whole can coordinate their efforts in an or-
ganized program for the Home Care and
Restoration of the chronically ill in a rural
area. Further, to determine the number of
people and the funds necessary to provide
restoration services which aim at self-care
and/or self-support of the patients."

Aims and Achievements
This home care program in Person Coun-
ty has been in operation since September
8, 1958. We think that the following results
have been achieved :

1. The first rural Home Care Project
has been established.

2. The project has been developed with-
out serious conflicts of interest.

3. It has had public acceptance.

4. There has been a gradual build-up of
patients admitted to the program.

5. A harmonious working relationship
with the doctors has been maintained.

6. A physical therapy department has
been prepared and equipped at the
county hospital.

7. The community has united to support
and promote the project.

8. The project has provided a health
education topic.

There have been problems as may be ex-
pected with any new program; but these
were chiefly associated with record devel-
opment and recruitment of specialized per-
sonnel.

You might ask, "What are the antici-
pated results?" I will list the major aims.

1. To provide information about the
cost of home care in a rural area.

2. To shorten the period of hospital
stay for patients with long-term ill-
ness.

3. To extend into the home services
ordinarilv restricted to hospital.

4. To reduce the number of people dis-
abled by chronic conditions.

5. To effect a reduction of cost to the
county for hospital and welfare care
for persons with long-term illness.

6. To provide adequate medical care for
the people of Person County.

Analysis of Results

Between September 8, 1958, and Decem-
ber 31, 1959, 55 patients had been referred.
Of these, 54 were admitted to the program
and given service. Before a person is ac-
cepted several things must be done:

1. The patient is referred by a doctor,
using a form developed by the team.

2. Representatives of all disciplines
visit and evaluate patient.

3. An admission conference is held with
the following in attendance: the phy-
sician in charge of case, the medical
social worker, the physical therapist,
a Public Health nurse, and other in-
terested persons.

4. Patient must show potential for re-
storation to self-help or employment.

Up to the present time, 13 patients have
been discharged (by conference similar to
admission conferences) from the program,
with 40 active at the present time and 1
classed as inactive. Of the 13 discharged,
2 achieved maximum benefits, 6 died, 3
moved out of the county, and 2 were dis-
charged for other reasons. Of the 40 given
service, 29 were classed as active in the
home, 5 as active out-patients, and 6 as ad-
visory in the home. When the program be-
gan, there were 3 chronically ill persons in
the local hospital who had been there more
than a year. Today 2 of these are at home
and the third has died. One of the patients
that we are caring for in the home today
reportedly cost a hospital in a neighboring
county $17,000 before discharge.

You will recall that to date 6 patients
have died. This mortality can be explained
by the fact that the median age for patients
accepted on the program is slightly more
than 67 years. Of the total 45 given care
during the past three months, 12 were 60
to 69 years of age, 13 were 70 to 79, and
4 were more than 80.

Thirty-five of the patients were white
and 10 were non-white, eighteen were male
and 27 were female. The socioeconomic
classification was as follows : high bracket,

July, 1960

RURAL HOME CARE— GARVIN

285

6; middle bracket, 16; low bracket, 10;
Public Assistance recipients, 13. Please
note that we do not deny admission to any-
one because of financial status or race.

Of the 45 patients handled during the
past three months, primary diagnoses were
as follows: cardiovascular accidents, 15;
arthritis, 11; fractures, 9; neurologic dis-
orders, 5 ; burns, 2 ; scoliosis, 1 ; multiple
sclerosis, 1; muscular distrophy, 1. You
might be surprised to learn that obesity
was listed as the secondary diagnosis in 6
cases ; arthritis in 5 ; high blood pressure in
5; diabetes in 4. Many other conditions
made up the remainder.

To render the needed services to these
patients, 36 admission conferences, 90 re-
view conferences, and 4 discharge confer-
ences have been held during the past year,
for a total of 130. Visits made to patients
by members of the health department team
were 630 by public health nurses, 849 by
the physical therapist, and 96 by the med-
ical social worker. These figures may sound
small, until it is remembered that we are
working in a small county with a limited
staff, limited financial resources, and that
we have experienced difficulties in securing
qualified personnel.

I have said that the project would pro-
vide care only for persons who will benefit
and can be restored to self-care or self-
support. The project itself does not provide
for the admission of terminal care cases.
Patients needing terminal care are ad-
mitted to the general public health program
and are serviced by the staff of the Health
Department.

Conclusioyi
The people of Person County are proud
of the fact that this is the first project of
its kind to be carried on in a rural area in
the United States. We are determined to
make it work and to provide answers to the
questions posed by those supporting the
project. The questions are:

1. What are the benefits derived from
such a project?

2. Are they too expensive?

3. How can medical care of the chron-
ically ill be financed best?

We are convinced that the project and
the Home Care Program provides aid and
assistance to the general practitioner or lo-
cal practitioner in the care of his patient
in the county hospital and the home.

SPECIAL REPORT

Report on Actions of the House of Delegates

American Medical Association

One Hundred Ninth Annual Meeting

June 13-17, 1960

Miami Beach

Health care for the aged, pharmaceutical
issues, occupational health programs, rela-
tions with allied health groups, and rela-
tions with the National Foundation were
among the major subjects involved in policy
actions by the House of Delegates at the
American Medical Association's One Hun-
dred Ninth annual meeting held June 13-17
in Miami Beach.

Dr. Leonard W. Larson of Bismarck,
North Dakota, former chairman of the
A. M. A. Board of Trustees and of the
A. M. A. Commission on Medical Care
Plans, was named president-elect by unan-
imous vote. Dr. Larson will succeed Dr. E.
Vincent Askey of Los Angeles as president
at the Association's annual meeting in
June, 1961, at New York City.

The A. M. A. 1960 Distinguished Service
Award, one of medicine's highest honors,
was given to Dr. Charles A. Doan, who will
retire next year as dean of the Ohio State
University College of Medicine and director
of the Health Center in Columbus, Ohio.

Total registration through Thursday,
with half a day of the meeting still remain-
ing, had reached 19,107, including 8,706
physicians.

Health Care For The Aged

After considering a variety of reports,
resolutions and comments on the subject of
health care for the aged, the House of Dele-
gates adopted the following statement as
official policy of the American Medical As-
sociation :

Personal medical care is primarily the respon-
sibility of the individual. When he is unable to
provide this care for himself, the responsibility
should properly pass to his family, the commun-
ity, the county, the state, and only when all
these fail, to the federal government, and then
only in conjunction with the other levels of gov-
ernment, in the above order. The determination
of medical need should be made by a physician
and the determinati"^ of eligibility should be
made at the local levei .vi+h local administration

This report was forwarded to the Journal by Dr. Klias
Faison of Charlotte, Secretary of the North Carolina dele-
gates to the A.M. A.

286

NORTH CAROLINA MEDICAL JOURNAL

July, 196fl

and control. The principle of freedom of choice
should be preserved. The use of tax funds under
the above conditions to pay for such care,
whether through the purchase of health insur-
ance or by direct payment, provided local op-
tion is assured, is inherent in this concept and is
not inconsistent with previous actions of the
House of Delegates of the American Medical
Association.

The House also urged the Board of
Trustees "to initiate a nonpartisan open
assembly to which all interested represen-
tative groups are invited for the purpose
of developing the specifics of a sound ap-
proach to the health service and facilities
needed by the aged, and that thereafter the
American Medical Association present its
findings and positive principles to the peo-
ple."

In connection with an educational pro-
gram regarding the aged, the House de-
clared that "the American Medical Associa-
tion increase its educational program re-
garding employment of those over 65, em-
phasizing voluntary, gradual and individual
retirement, thereby giving these individuals
not only the right to work but the right to
live in a free society with dignity and
pride."

Earlier, at the opening session, Dr. Louis
M. Orr, retiring A. M. A. president, had
asked the House to go on record favoring
more jobs for the aged, voluntary retire-
ment and a campaign against discrimina-
tion because of age, whether it be 40 or 65.
The House also gave wholehearted approv-
al to Dr. Askey's urging that state medical
societies take an active part in state confer-
ences and other planning activities preced-
ing the January, 1961, White House Con-
ference on Aging.

Pharmaceutical Issues

In the pharmaceutical area the House
took two actions — one regarding mail order
drug houses and the other involving the
development and marketing of pharma-
ceutical products.

The House agreed with representatives
of the pharmacy profession that the unor-
thodox practice of mail order filling of pre-
scription drugs is not in the best interest of
the patient, except where unavoidable be-
cause of geographic isolation of the patient.
The statement pointed out that in this pro-
cess the direct personal relationship, which
exists between the patient-physician-phar-

macist at the community level and which is
essential to the public health and the wel-
fare of patients, is lost.

The House also directed the Board of
Trustees to request the Council on Drugs
and other appropriate Association councils
and committees "to study the pharmaceu-
tical field in its relationship to medicine and
the public, to correlate available material,
and after consultation with the several
branches of clinical medicine, clinical re-
search, and medical education and other in-
terested groups or agencies, submit an ob-
jective appraisal to the House of Delegates
in June, 1961." The statement pointed out
that certain proposals have been made
which, if carried out, might impair the
future of pharmaceutical research and de-
velopment, thus retarding the progress of
scientific therapy. It also said that the
services of the pharmaceutical industry are
so vital to the public and to the medical
profession that an objective study should
be made.

Occupational Health Programs

The House approved a revised statement
on the "Scope, Objectives and Functions of
Occupational Health Programs," which was
originally adopted in June, 1957. The new
statement contains no fundamental alter-
ations in A. M. A. policy or ethical rela-
tionships, but it adds important new ma-
terial on the following points:

1. Greater emphasis on the preventive
and health maintenance concepts of oc-
cupational health programs.

2. A more positive statement of organ-
ized medicine's obligation to provide
leadership in improving occupational
health services by part-time physicians
in small industry.

3. Increased emphasis on rehabilitation
of the occupationally ill and injured.

4. Inclusion of the proper use of immun-
ization procedures for employes, as ap-
proved by the House in 1959.

5. A more adequate statement on the
need for teamwork with lay industrial
hygienists in tailoring each occupa-
tional health program to the particular
employe group involved.

In approving the revised guides for oc-
cupational health programs, the House also
accepted a suggestion that the A. M. A.
Council on Occupational Health undertake

July, 1960

ADVERTISEMENTS

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References: 1. Feinberg, S. M.J Feinberg, A. R., and Fisherman.
E. W.: J. A.M. A. 167:58 (May 3) 1958. 2. Epstein. J. I., and Sher-
wood. H. : Conn. Med. 22:822 (Dec.) 1958. 3. Friedlaender. S.. and
Friedlaender. A. S. : Antibiotic Med. & Clin. Ther. 5:315 (May)

1958. 4. Segal. M. S.. and Duvenci. J.: Bull. Tufts N.E. Medical
Center 4:71 (April-June) 1958. 5. Segal. M. S. : Report to the
A.M. A. Council on Drugs. J.A.M.A. 169:1063 (March 7) 1958.

6. Hartung. E. F. : /. Florida Acad. Gen. Practice 8:18. 1957.

7. Rein. C. R. ; Fleischwager. R., and Rosenthal. A. L. : J.A.M.A.
165: 1821 (Dec. 7) 1957. 8. McGavack. T. H. : Clin. Med. (June!

1959. 9. Freyberg, R. H. ; Berntsen, C. A., and Hellman. L. :
Arthritis & Rheumatism 1:215 (June! 1958. 10. Hartung. E. F. :
J.A.M.A. 167:973 (June 21) 1958. 11. Zuckner. J.; Ramsey. R. H.J
Caciolo, C. and Gantner. G. E. : Ann. Rheumat. Dis. 17:398 (Dec.)
1958. 12. Appel, B. ; Tye, M. J., and Leibsohn, E. : Antibiotic Med.
& Clin. Ther. 5:716 (Dec.) 1958. 13. Kalz. F. : Canad. M.A.J.
79:400 (Sept.) 1958. 14. Mullins, J. F.. and Wilson, C. J.: Texas J.
Med. 54:648 (Sept.) 1958. 15. Shelley. W. B.; Harun. J. S.. and
Pillsbury, D. M. : J.A.M.A. 167:959 (June 21) 1958. 16. DuBois.
E. L. : J.A.M.A. 167:1590 (July 26) 1958. 17. McGavack. T. H.;
Kao. K. T.; Leake, D. A.; Bauer, H. G., and Berger. H. E. : Am.
J. M. Sc. 236:720 (Dec.) 1958. 18. Council on Drugs: J.A.M.A.
169:257 (January) 1959.

lid^u:

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A special report to members of the Medical Society of

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in effect since 1940

PROUDLY WE REPORT 1959

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July, 1960

SPECIAL REPORT

287

a project to study and encourage the em-
ployment of the physically handicapped.

Allied Health Groups

The House approved the final report of
the Committee to Study the Relationships
of Medicine with Allied Health Professions
and Services and commended it as " a mon-
umental work." The report covers the pre-
sent situation, future implications and re-
commendations, including guiding princi-
ples and approaches to activate physician
leadership. The House strongly recom-
mended that A. M. A. activity in this vital-
ly important area be continued, and it ap-
proved the appointment of a Board of
Trustees committee to carry on the work.

To develop physician leadership in pro-
moting cooperative efforts with allied
health professions and services, the report
suggested the following A. M. A. activities.

1. A general conference should be held
with allied scientists in the basic med-
ical sciences and related disciplines for
discussion of matters of common con-
cern related to the creation of perma-
nent, cooperative activities.

2. Specific exploratory conferences should
be held with members of segments of
science allied to a given area of med-
ical practice with the national medical
organizations concerned.

3. General and specific conferences should
be held with professional and technical
assistants on education, recruitment,
and coordination of contributions.

4. Through meetings and publications,
reciprocal exchange of information
should be provided between physicians
and allied scientists and members of
health professions.

5. Effective, continuing liaison should be
established between A. M. A. repre-
sentatives and professional and tech-
nical personnel.

National Foundation

The House took two actions involving re-
lations between the medical profession and
the National Foundation. It adopted a state-
ment of policies for the guidance of state
medical associations and recommended that
they be adopted by all component medical
societies. These policies cover such subjects
as membership of medical advisory commit-

tees, and basic principles concerning finan-
cial assistance for medical care, payment
for physicians' services and physicians' re-
sponsibilities for constructive leadership in
medical advisory activities.

In another action the House directed the
Board of Trustees to authorize further
conferences with leaders in the National
Foundation on the problem of poliomyelitis
as it relates to the betterment of the public
health and to consider further joint action
toward the eradication of polio. The House
commended the National Foundation for its
outstanding service in the attack against
polio, but pointed out that much work re-
mains to be done in public education, vac-
cination, continuing assistance for polio vic-
tims, and research.

Miscellaneous Actions

In dealing with reports and resolutions
on a wide variety of other subjects, the
House also:

Strongly reaffirmed its support of the
Blue Shield concept in voluntary health in-
surance and approved specific recommenda-
tions concerning A. M. A. — Blue Shield re-
lationships;

Approved a contingent appointment of
not more than six months for foreign med-
ical school graduates who have been ac-
cepted for the September, I960, qualifica-
tion examination ;

Agreed that the American Medical Asso-
ciation should sponsor a second National
Congress on prepaid health insurance;

Approved a Board of Trustees request to
the Postmaster General for a stamp com-
memorating the Mayo Brothers;

Decided that the establishment of a home
for aged and retired physicians is not war-
ranted at this time.

Approved the establishment of a new
"Scientific Achievement Award" to be
given to a non-physician scientist on special
occasions for outstanding work;

Approved the following schedule for fu-
ture annual meetings : Atlantic City, 1963 ;
San Francisco, 1964, and New York City,
1965;

Approved the objectives of the A. M. A.
Commission on the Cost of Medical Care
established by the Board of Trustees and
headed by Dr. Louis M. Orr, immediate
past president of the Association ;

Urged individual members of the Asso-
ciation to take a greater interest and more

288

NORTH CAROLINA MEDICAL JOURNAL

July. 19G0

active part in public affairs on all levels;

Reaffirmed its opposition to compulsory
inclusion of physicians under Title II of
the Social Security Act and recommended
immediate action by all A. M. A. members
who agree with that position ;

Called for a review of existing and pro-
posed legislation pertaining to food unci
color additives, with the objection of sup-
porting appropriate measures which are in
the public interest;

Urged reform of the federal tax struc-
ture so as to return to the states and their
political subdivisions, their traditional re-
venue sources;

Asked state and county medical societies
to make greater use of A. M. A. recruit-
ment materials in presenting medicine's
story to the nation's high schools ;

Requested the Board of Trustees to ini-
tiate a study of present policy regarding
the required content and method of prepar-
ing hospital records;

Commended the Department of Defense
and the Air Force for establishing and op-
erating the Aeromedical Transport Service
and urged that it be maintained at optimum
efficiency ;

Directed the Board of Trustees to devel-
op group annuity and group disability in-
surance programs for Association mem-
bers; and

Expressed grave concern over the indis-
criminate use of contact lenses.

Addresses and Awards

Dr. Orr, in his final report to the House
at the opening session, urged medical so-
cieties to "adopt" rural villages, cities, and
regions in underdeveloped parts of the
world and to send them medical, clinical,
and hospital supplies.

Dr. Askey, in his inaugural address
Tuesday night, declared that medicine faces
its greatest challenge in the decade ahead,
adding that physicians must prove the ef-
fectiveness of medicine practiced in a free
society. Dr. John S. Millis (Ph.D.), presi-
dent of Western Reserve University, Cleve-
land, Ohio, and guest speaker at the in-
augural ceremonies, said the human dilem-
ma of the sixties is an increasing desire for
security and authority with a diminishing
desire for responsibility.

At the Wednesday session of the House,
Dr. Askey urged intensified, accelerated ef-

fort in five areas — medical education,
preparations for the White House Confer-
ence on Aging next January, health insur-
ance and third party relationships, mental
health, and membership relations.

The Goldberger Award in Nutrition was
presented to Dr. Richard Vilter of the Uni-
versity of Cincinnati. The Boy Scouts of
America, celebrating its golden jubilee,
presented the A. M. A. with a citation in
appreciation of the medical profession's
help and support. Dr. B. E. Pickett of Car-
rizo Springs, Texas, retiring chairman of
the Council on Constitution and Bylaws,
received an award in recognition of his
long service.

Election of Officers

In addition to Dr. Larson, the new pres-
ident-elect, the following officers were
named at the Thursday session :

Dr. William F. Costello of Dover, N. J.,
vice president; Dr. Norman A. Welch of
Boston, re-elected speaker of the House,
and Dr. Milford 0. Rouse of Dallas, Texas,
re-elected vice speaker.

Dr. Gerald D. Dorman of New York City
was elected to the Board of Trustees to suc-
ceed Dr. Larson, and Dr. James Z. Appel of
Lancaster, Pennsylvania, was re-elected to
the Board.

Elected to the Judicial Council, to suc-
ceed Dr. Louis A. Buie of Rochester,
Minnesota, was Dr. James H. Berge of
Seattle.

Named to the Council on Medical Educa-
tion and Hospitals were Dr. William R.
Willard of Lexington, Kentucky, succeed-
ing Dr. James M. Faulkner of Cambridge,
Massachusetts, and Dr. Harlan English of
Danville, Illinois, who was re-elected.

On the Council on Medical Service, the
House re-elected Dr. Russell B. Roth of
Erie, Pennsylvania, and Dr. Hoyt B. Wool-
ley of Idaho Falls.

Dr. George D. Johnson of Spartanburg,
S. C, was named to succeed Dr. Pickett on
the Council on Constitution and Bylaws.

F. J. L. Blasingame, M.D.
Executive Vice President
American Medical Association

July, 1960

EDITORIALS

289

North Carolina Medical Journal

Owned and published by

The Medical Society of the State of North Carolina,

under the direction of its Editorial Board.

EDITORIAL BOARD
Wingate M. Johnson, M.D., Winston-Salem

Editor
Miss Louise MacMillan, Winston-Salem

Assistant Editor
Mr. James T. Barnes, Raleigh

Business Manager
Ernest W. Furgurson, M.D., Plymouth
John Borden Graham, M.D., Chapel Hill
G. Westbrook Murphy, M.D., Asheville
William M. Nicholson, M.D., Durham
Robert W. Prichard, M.D., Winston-Salem
Hubert A. Royster, M.D., Raleigh

Address manuscripts and communications regarding
editorial matter to the
NORTH CAROLINA MEDICAL JOURNAL
300 South Hawthorne Road, Winston-Salem 7, N. C.
Questions relating to subscription rates, advertis-
ing, ect., should be addressed to the Business
Manager, 203 Capital Club Building, Raleigh, N. C.
All advertisements are accepted subject to the ap-
proval of a screening committee of the State
Journal Advertising Bureau, 510 North Dearborn
Street, Chicago 10, Illinois, and/or by a Committee
of the Editorial Board of the North Carolina Medi-
cal Journal in respect to strictly local advertising
accepted for appearance in the North Carolina
Medical Journal.

Annual subscription, $5.00 Single copies, 75''

Publication office: Carmichael Printing Co., 1309

Hawthorne Road, S.W., Winston-Salem 1, N. C.

JULY, 1960

THE A.M.A.'s ONE HUNDRED NINTH
ANNUAL MEETING

The actions of the A.M. A. House of Dele-
gates are published elsewhere in this issue,
so only a few random impressions will be
given here.

The total registration was 22,484, in-
cluding 8,162 physicians. This was far be-
low last year's Atlantic City mark of 32,882,
including 13,143 physicians. Doubtless the
strike of Eastern Airline pilots called just
before the opening day of the meeting was
partly responsible for this falling off in
attendance. Without disparaging the hos-
pitality of the Florida medical profession,
however, it must be admitted that Miami
Beach was far from an ideal convention
site. The distance from the headquarters
hotel, the Americana, to the exhibition hall
was 7 miles and required 45 minutes or
more on one of the buses provided for
transportation. The section meetings were
widely scattered, and many doctors were
heard to express the same nostalgic feeling

for Atlantic City that members of our State
Society had expressed for Pinehurst.

The scientific and technical exhibits were
good, although not as well attended as they
would have been in a more favorable loca-
tion. Both Dr. Orr in his farewell address
and Dr. Askey in his inaugural address
did themselves proud.

The election of Dr. Leonard Larson as
president-elect met with universal approv-
al. He has richly earned this honor and can
be depended upon to carry on the good work
of his predecessors.

Our neighboring state, South Carolina,
was well recognized. Dr. Julian Price of
Florence was selected chairman of the
Board of Trustees to succeed Dr. Larson.
Dr. George Johnson of Spartanburg was
elected to succeed Dr. B. E. Pickett of Texas
as a member of the Council on Constitution
and By-laws. Dr. Pickett was given a stand-
ing ovation when he gave his final report
as chairman of this important Council.

THE OLD ORDER CHANGETH
Dr. Alfred Potter's Presidential Address,
delivered at the one hundredth forty-ninth
Annual Meeting of the Rhode Island Med-
ical Society and published in the June issue
of the Rhode Island Medical Journal, is
scholarly and thought-provoking. As the
one hundredth president of the Rhode
Island Society, Dr. Potter noted some of the
most important changes in medical prac-
tice that have occurred in the society's his-
tory.

He began by citing the record from the
Providence Lying-in Hospital of a patient
delivered by the matron. Since, fortunately
for the patient, "Because of the Sunday
horsecar delay the doctor was not present
. . . The patient's course was remarkable in
that at no time had the temperature risen
above 100." At that time the words of
Holmes and Semmelweiss had fallen on
deaf ears.

Dr. Potter commented that the economics
of medicine had changed as much as our
mode of transportation and our therapy.
More and more people depend on insurance,
and the depression era 5 to 1 ratio of serv-
ice to private patient has been reversed.
With the great increase in insurance, fees
for medical service are being standardized.
Dr. Potter deplores "the leveling of all
doctors to a median payment" as "leading

290

NORTH CAROLINA MEDICAL JOURNAL

July, I960

only to a dead level of mediocrity." He
equally deplores, however, overcharging pa-
tients, and is concerned because "it seems
that of late years more persons than form-
erly have entered medicine for financial
betterment or for status."

Two paragraphs deserve quoting in full:

The infrequent overcharging or other wrong-
doing in the way of unprofessional conduct by
a few brings discredit on all. To minimize this
situation we must be more than ever alert to
police our own profession. The general public
seems ready to believe the worst of us,
without waiting to have the evidence presented
and proved. From the very nature of our calling,
the fact that we are usually employed only at a
time of illness, suffering, anxiety, or grief, all
unpleasant emotions, makes us by association the
objects of unconscious disapproval and hostility.
Enricus Cordus expressed this common feeling
as far back as 1535 in these lines:

"Three faces wears the doctor; when first

sought,
An Angel's, . . . And a God's the cure half

wrought ;
But when the cure complete, he seeks his

fee,
The Devil looks less terrible than he."

I believe that a large part of the hostility
toward medicine, outspoken by labor leaders, and
rampant in many newspapers, is based on envy;
envy of the doctor's independence. "We few, we
happy few, we band of brothers" are of the few
remaining self-employed. We are not retired at
an arbitrarily fixed age while still fully or even
better able to continue working. We may work
as long and as many hours as we want or as our
health permits. Having proved our competence
to practice we are not displaced by changing
production methods or economic upheavals. We
have security, but only if we keep our health
and maintain and enlarge our skills with new-
knowledge. In a way we live dangerously, with
no pension plans paid for by an employer. But
we are our own masters, and I believe that for
this reason we are envied by our detractors. At
the same time, it is important to remember that
this freedom carries with it great responsibil-
ties.

Dr. Potter found some comfort, after he
had almost finished writing his address,
from reading in the 1912 Presidential Ad-
dress of Dr. Frederick Rogers :

"How shall we regain the respect, the
feeling- of security and confidence in the
medical profession which was such a strong
factor in human life a hundred years ago,
but which now is unfortunately lacking?"

And it is quite likely that a hundred
years before Dr. Rogers asked this ques-
tion, the more sensitive and intelligent
leaders of the profession were still smart-
ing from the caricature of doctors found in
Moliere's writings and in Hogarth's paint-
ings. Now, as then, our profession's most
effective public relations can, in Dr. Pot-
ter's concluding words, "best be regained
and maintained by our individual and per-
sonal contacts with our patients and other
laymen."

"SYMPTOMATIC MEDICINE"

"Symptomatic medicine" has acquired
the reputation of poor medicine, of the dis-
pensing of a series of pills to relieve a suc-
cession complaints in a patient with an
undiagnosed or incurable illness. It is gen-
erally referred to apologetically by the doc-
tor in charge of the case, or condescending-
ly or scathingly by another doctor review-
ing the case. Is such an attitude justified?
Why should not the patient's symptoms be
relieved?

The present century, because of the as-
tounding advances in diagnostic techniques
and in surgical and pharmacologic methods
of cure, has witnessed a change in the goal
of the medical profession. Cure of the dis-
ease, or, if that is not possible, restoration
of maximum function is now the aim,
rather than alleviation of suffering while
the disease runs its course in the patient.
It is true that if the disease is properly
diagnosed, and if a specific remedy is avail-
able and properly prescribed, then the
symptoms caused by the disease will abate
and eventually disappear as the disease is
healed, and a change in the symptoms may
be a useful gauge of the progress of the
treatment.

But what of the many symptoms caused
by "stress" or "tensions" or by unknown
disorders? The patient may obtain some re-
lief by learning that his headache is caused
by tension or sinusitis rather than the
brain tumor he feared, but he will still ex-
pect some more direct relief while awaiting
the benefits of measures directed toward
the underlying condition. If such relief is
not forthcoming, the less tolerant or less
patient patient will seek help elsewhere —

Reprinted from the Journal of the Florida Medical Asso-
ciation 46:1262-1253 (April) 1960.

July, 1960

EDITORIALS

291

which explains why the quack and cultist
still flourish in this age of medical miracles.

One other point should be made. It is
often thought that "symptomatic medicine"
is easy — that the relief of a symptom in-
volves a thorough grounding not only in
physiology but also in the psychology of the
doctor as well as the patient, and prescrib-
ing for the symptoms presupposes an up to
date knowledge of pharmacology.

The relief of symptoms is still the prin-
cipal desire of patients coming to the phy-
sician. There should be no shame or stigma
attached to granting such relief, provided
the cause of the symptoms is understood.
For a remarkably lucid and complete ex-
position on this subject the interested read-
er is referred to Dr. Walter ModelPs mon-
ograph.'1*

1. Modell, Walter: The Relief of Symptoms, Philadelphia,
W. B. Saunders Company, 1955.

NURSES AND NURSING

No doubt many doctors will say a hearty
"Amen" to Miss Vivian Culver's paper in
this issue of the Journal. Many nurses, also,
have been concerned about the trend in
nursing education to emphasize the theory
of nursing at the expense of patient care.
As Miss Culver expressed it, we are short
of both nurses and nursing.

It is true that more and more nurses are
expected to carry out procedures formerly
done only by doctors — such as taking blood
pressures. Parenthetically, this plan has the
great advantage that nursing ministrations
are so taken for granted by the average pa-
tient that almost as a rule the pressures
taken by the nurse are lower than those
taken by the doctor.

There has been a regrettable tendency to
exalt the administrative role of the nurse
at the expense of the active nursing care of
the patient. Both types of nurses are
needed, and both are important. The nurse
who really enjoys patient care, however,
should not be made to feel inferior to the
supervisor type.

What the late Francis Peabody said of
the medical practice applies equally well to
nursing: "The secret of the care of the pa-
tient is caring for the patient."

MEDICAL PREPAYMENT AND
OUR SOCIAL PHILOSOPHY

"A curious paradox of some contem-
porary social philosophy is the idea that
man should spend what he earns for his
pleasures rather than for what he needs.
It is appropriate, so this reasoning goes,
that he should buy a television set, a vaca-
tion in Florida or an outboard motor boat,
because there are cardinal rights. But for
something that he really needs, such as his
life or his health, or the life of his child,
someone else should pay. This may be the
Government, his employer, his union, his
great-aunt or anyone else who can be ca-
joled or coerced into paying the price for
him. If no one else will pay for it, the
doctor should serve him for nothing."

This observation by Dr. C. Marshall Lee,
Jr.,111 raises a question of crucial impor-
tance not only to the medical economy but
to the whole pattern of our American so-
ciety.

For, as Dr. Lee puts it, the attitude he
describes "may be acceptable for the child
of an indulgent parent, but it is not appro-
priate for a free man in a free society."

What can the doctor do to counteract
this philosophy and to forestall the social-
ization of medicine which may be its ulti-
mate product?

First, the doctor should learn all he can
learn about our voluntary medical prepay-
ment programs. Physicians should recog-
nize that, in Dr. Lee's words, "Far from
being the meddlesome 'third party' for
which they have an uneasy fear, (the pre-
payment program) stands with them in the
common effort to preserve a cherished
concept of freedom."

Secondly, the doctors — and only he — can
make these programs operate to the satis-
faction of the patient. Only he can see to it
that the subscriber gets full value for the
premium dollar he has invested in our vol-
untary medical care program.

Finally, the medical profession's own
sponsored Blue Shield Plans offer the
American doctor an opportunity not only
to strengthen and confirm his patient's
confidence in our traditional way of prac-
ticing medicine, but also to participate
actively in guiding the destiny of our med-
ical prepayment program in the days ahead.

292

NORTH CAROLINA MEDICAL JOURNAL

July. 1960

CORRESPONDENCE
To the Editor:

Recently I received from the Board of
Medical Examiners of the State of North
Carolina a pamphlet listing the registered
physicians in the state of North Carolina.
Although I did not count the exact number
registered I estimated that approximately
five thousand physicians were registered in
this pamphlet. It appears that the intake
from this project is amounting to over $25
thousand.

In the foreword in this pamphlet the
Board of Medical Examiners of the State
are nice enough to give an exact copy of the
law wherein this taxation is ordered. How-
ever, I do not read in the law as published
any direction wherein money will be spent
from this collection to publish and mail out
a pamphlet such as I have received. As I
am a member of the North Carolina Med-
ical Society I find that the roster which is
published by the Society is much more con-
venient and comprehensive as to the infor-
mation on doctors in North Carolina. In
fact, the pamphlet as put out by the Board
of Medical Examiners is grossly lacking in
the information and consequently will serve
no purpose due to the fact that the roster
published by the Medical Society is better.

How many years will the physicians of
North Carolina have to be bled for $25
thousand or more every two years for them
to finally realize that this is just another
unnecessary taxation placed upon them?

I sincerely hope that you will take some
steps to bring this matter before the mem-

bership of the North Carolina Medical So-
ciety in an effort to get them to voice their
feeling on this taxation and to take a firm
stand on its approval or disapproval. If the
consensus is toward approval then it should
be so stated. If the voice is for disapproval
then I think the Medical Society JOURNAL
should be the place for the beginning of a
campaign to have this law removed with all
expediency.

The internal revenue department knows
the physicians of the state, the military
knows the names of the physicians it may
need, the North Carolina Medical Society
has a roster of its members, the North
Carolina Board of Medical Examiners now
have a complete list of the physicians of
the state, so now, who can defend the per-
petuation of this unfair and unnecessary
piece of legislation?

J. R. Gamble, Jr., M.D.

Lincolnton

Note : The Biennual Registration Act
was recommended after long deliberation
by the Board of Medical Examiners, and
adopted by a large majority of the dele-
gates at its 1956 meeting. The reasons for
it were given by Dr. Combs in a guest edi-
torial in the December, 1957, issue. Since
the North Carolina Medical Journal is
the official organ of the North Carolina
Medical Society, it would not be consistent
for it to lead a crusade against a policy ap-
proved by a majority of our House of Dele-
gates. The columns of the Journal, how-
ever, are open to any members who wish to
give their views on this or any other action
of the Society. — Ed.

• •••a a Greensboro

• »0 Raleigh

Washington#Q t~fi

MATERNAL DEATHS REPORTED IN NORTH CAR0L1NA\ /

SINCE JANUARY I, I960 \W"^.n9,onn-

Each dot represents one death

July, 19G0

293

Committees and Organizations

SCHEDULE OF COMMITTEE AND
COMMISSION APPOINTMENTS, 1960-1961

NOTE: The Committees listed herein have been authorized by President Amos N. Johnson,
and/or are required under the Constitution and By-Laws.

Particular note should be taken of the authorization of the House of Delegates of
a Commission form of organizational activity and that all Committees, excepting Com-
mittee on Nomination, Committee on Negotiation, and Committee on Grievances, are seg-
regated under the respective Commission in which the function of the committee log-
ically rests. This will tend to eliminate overlapping and duplication in activity programs
and result in coordination of the work of the Society in a manner to lessen the work of
the delegates in the Annual Meeting of the House of Delegates.

(The President, Secretary and Executive Director of the Society are ex-officio
members of all committees and, along with the Commission Chairman, should receive no-
tice of meetings, agenda and minutes of committee meetings during the activity year.)

I. ADMINISTRATION COMMISSION

Wayne J. Benton, M.D., Chairman

2320 Battleground Rd. Committee

Greensboro, North Carolina listing

1. Finance, Committee on (1-1) #19

Wavne J. Benton, M.D., Chairman
2320 Battleground Rd.
Greensboro, North Carolina.

2. Liaison to Study Integration of Negro #44
Physicians into Medical Society of State of
North Carolina

J. Street Brewer, M.D., Chairman

P.O. Box 98

Roseboro, North Carolina

II. ADVISORY AND STUDY COMMISSION

Jacob H. Shuford, M.D., Chairman
7 Main Avenue Place, S. W.
Hickory, North Carolina

1. Auxiliary Advisory and Archives of Medical
Society History, Committee on, (II-l) #1

Roscoe D. McMillan, M.D., Chairman

P. O. Box 232

Red Springs, North Carolina

2. American Medical Education Foundation,
Committee on, (II-2) #2

Ralph B. Garrison, M.D., Chairman
222 N. Main Street
Hamlet, North Carolina

3. Blue Shield, Committee on (II-3) #8
Jacob H. Shuford, M.D., Chairman

7 Main Avenue Place, S. W.
Hickory, North Carolina

4. Constitution and By-Laws,

Committee on, (II-4) #13

Roscoe D. McMillan, M.D., Chairman

Box 232

Red Springs, North Carolina

5. Credit Bureau,

Committee on Medical, (II-5) #14

W. Howard Wilson, M.D., Chairman
403 Professional Building
Raleigh, North Carolina

6. Industrial Commission of North Carolina
Committee to Work with, (II-6) #23
Thomas B. Dameron, Jr., M.D., Chairman
1313 Daniels Street

Raleigh, North Carolina

7. Medical Care of Dependents of Members of
Armed Forces, (MEDICARE)
Committee on, (II-7) #28
David M. Cogdell, M.D., Chairman

911 Hay Street
Fayetteville, North Carolina

8. Student A.M.A. Chapters,

Committee Advisory to, (II-8) #41

John P. Davis, M.D., Chairman
821 Nissen Building
Winston-Salem, North Carolina

III. ANNUAL CONVENTION COMMISSION

R. Beverly Raney, M.D., Chairman
North Carolina Memorial Hospital
Chapel Hill, North Carolina

1. Arrangements, (of Facilities Annual
Session), Committee on, (III-l) #4
John S. Rhodes, M.D., Chairman

700 West Morgan Street
Raleigh, North Carolina

2. Audio-Visual Scientific Postgraduate
Instruction, Committee on, (III-2) #5
J. Leonard Goldner, M.D., Chairman

Duke Hospital

Durham, North Carolina

3. Awards, Committee on, (III-3) #6
To be announced in Fall

4. Delegates, Committee on Credentials

to House of Delegates (III-4) #15

T. Tilghman Herring, M.D., Chairman
Wilson Clinic
Wilson, North Carolina

5. Exhibits, Committee on Scientific,

(III-5) #17

Raphael W. Coonrad, M.D., Chairman
Broad & Englewood
Durham, North Carolina

6. Golf Tournament, Committee on

Medical (III-6) #21

Wm. A. Brewton, M.D., Chairman

5 Lake Dr.

Enka, North Carolina

7. Scientific Works, Committee on (III-7) #7
Wm. McN. Nicholson, M.D., Chairman
Duke Hospital

Durham, North Carolina

IV. PROFESSIONAL SERVICE COMMISSION

George W. Paschal, Jr., M.D., Chairman
1110 Wake Forest Rd.
Raleigh, North Carolina

1. Emergency Medical and Military Service
Committee on (IV-1) #16
George W Paschal, Jr., M.D., Chairman
1110 Wake Forest Rd.

Raleigh, North Carolina

2. Eye Care and Eye Bank,

Committee on (IV-2) #18

George T. Noel, M.D., Chairman
211 Raleigh Building
Kannapolis, North Carolina

294

NORTH CAROLINA MEDICAL JOURNAL

July, I960

3. Insurances, Committee on, (IV-3) #24

Joseph W. Hooper, Jr., M.D., Chairman
410 North 11th Street
Wilmington, North Carolina

4. Necrology, Committee on, (IV-4) #30
Charles H. Pugh, M.D., Chairman

Box 527

Gastonia, North Carolina

5. Nursing, Committee of Physicians on,
(IV-5) #33
Robert R. Cadmus, M.D., Chairman

N. C. Memorial Hospital
Chapel Hill, North Carolina

6. Postgraduate Medical Study,

Committee on (IV-6) #35

Samuel L. Parker, Jr., M.D., Chairman
Kinston Clinic
Kinston, North Carolina

V. PUBLIC RELATIONS COMMISSION

Hubert Mc.N. Poteat, Jr., M.D., Chairman
713 Wilkins Street
Smithfield, North Carolina

1. Hospital and Professional Relations and
Liaison to North Carolina Hospital
Association, Committee on (V-l) #22
Theodore H. Mees, M.D., Chairman

501 West 27th Street
Lumberton, North Carolina

2. Legislation, Committee on, (V-2) #25
Hubert McN. Poteat, Jr., M.D., Chairman
713 Wilkins Street

Smithfield, North Carolina

3. Medical-Legal Committee (V-3) #27
Julius A. Howell, M.D., Chairman
Bowman Gray School of Medicine
Winston-Salem, North Carolina

4. Public Relations, Committee on (V-4) #37
Edgar T. Beddingfield, Jr., M.D., Chairman
P. O. Box 137

Stantonsburg, North Carolina

5. Rural Health and General Practitioner
Award, Committee on (V-5) #39
R. Vernon Jeter, M.D., Chairman
Plymouth Clinic

Plymouth, North Carolina

6. Insurance Industry Liaison Committee #43
Frank W Jones, M.D., Chairman
Catawba Hospital

Newton, North Carolina

VI. PUBLIC SERVICE COMMISSION

John R. Kernodle, M.D., Chairman
Kernodle Clinic
Burlington, North Carolina

1. Anesthesia Study, Committee on, (VI-1) #3
David A. Davis, M.D., Chairman

North Carolina Memorial Hospital
Chapel Hill, North Carolina

2. Board of Public Welfare of North Carolina,
Committee Advisory to, (VI-2) #9
J. Street Brewer, M.D., Chairman

P. O. Box 98

Roseboro, North Carolina

3. Cancer, Committee on, (VI-3) #10
James F. Marshall, M.D., Chairman

310 West 4th Street
Winston-Salem, North Carolina

4. Child Health, Committee on, (VI-4) #11
Angus M. McBrvde, M.D., Chairman

809 West Chapel Hill Street
Durham, North Carolina

5. Chronic Illness, Tuberculosis and Heart
Disease, Committee on, (VI-5) #12
John R. Kernodle, M.D., Chairman
Kernodle Clinic

Burlington, North Carolina

5. Maternal Health, Committee on, (VI-6) #26
James F. Donnelly, M.D., Chairman
State Board of Health
Raleigh, North Carolina

7. Mental Health, Committee on, (VI-7) #29
AUvn B. Choate, Ai.U., Chairman

1012 Kings Drive
Charlotte, North Carolina

8. Occupational Health, Committee on,

(VI-8) #34

Hurry L. Johnson, M.D., Chairman

P. O. Box 530

Elkin, North Carolina

9. Poliomyelitis, Committee on, (VI-9) #3fi
Samuel F. Ravenel, M.D., Chairman

104 E. Northwood Street
Greensboro, North Carolina

10. Rehabilitation Physical,

Committee on (VI-10) #38

George W. Holmes, M.D., Chairman
2240 Cloverdale Avenue
Winston-Salem, North Carolina

11. School Health, Committee on, (VI-11) #40
Irma C. Henderson Smathers, M.D.,

Chairman
1295 Merrimon Avenue
Asheville, North Carolina

12. Veterans Affairs, Committee on, (VI-12) #42
Samuel L. Elfmon, M.D., Chairman

225 Green Street
Fayetteville, North Carolina

VII. NOMINATIONS, COMMITTEE ON (not
commission constitutionally provided) #32

Jacob H. Shuford, M.D., Chairman
7 Main Ave. Place, S.W.
Hickory, North Carolina

VIII. GRIEVANCES, COMMITTEE ON, (not a
commission By-Law provided) #20

James P. Rousseau, M.D., Chairman
1014 W. Fifth Street
Winston-Salem, North Carolina

IX. NEGOTIATIONS, COMMITTEE ON, (not a
commission By-Law provided) #31
Wm. F. Hollister, M.D., Chairman

Moore County Hospital
Pinehurst, North Carolina
1. Committee Advisory to the Auxiliary and

Archives of Medical Society History (14} II-l
Roscoe D. McMillan, M.D., Chairman, Box

232, Red Springs
Ethel May Brownsberger, M.D., 75 Hender-

sonville Road, Biltmore
Warner L. Wells, M.D., Consultant, N. C.

Memorial Hospital, Chapel Hill
Coy C. Carpenter, M.D., Consultant, Bowman

Gray, Winston-Salem
Wilburt C. Davison, M.D., Consultant,

Roaring Gap
Joseph M. Hitch, M.D., 415 Professional

Bldg., Raleigh
Wingate M. Johnson, M.D., 300 S. Hawthorne

Road, Winston-Salem
Rose Pully. M.D., 1007^ N. College Street.

Kinston
Ivan M. Procter, M.D., 209 Hillcrest Road,

Raleigh
Jean Bailey Brooks, M.D , 1100 N. Elm

Street, Greensboro
James P. Rousseau, M.D., 1014 West Fifth

Street, Winston-Salem
Ben F. Royal, M.D., 900 Shepherd Street,

Morehead City

James Tidier, M.D.,

mington
Paul F. Whitaker,

Street, Kinston

1010 Grace Street, Wil-
M.D., 1205 N. Queen

July, 1960

SCHEDULE OF COMMITTEE APPOINTMENTS

295

Committee on American Medical Education
Foundation (AMEF) (7) II-2

Ralph B. Garrison, M.D., Chairman, 222 N.
Main Street, Hamlet

Wm. LeRoy Fleming, M.D., UNC School of
Medicine, Chapel Hill

J. Bivins Helms, M.D., Box 24, Morganton

Harry L. Johnson, M.D., Box 530, Elkin

Paul F. Maness, M.D., 328 W. Davis Street,
Burlington

Manson Meads, M.D., Bowman Gray, Win-
ston-Salem

Wm. Pettway Peete, M.D., Duke Hospital,
Durham

Committee on Anesthesia Study Commission
(11) VI-1

David A. Davis, M.D., Chairman, N. C. Mem-
orial Hospital, Chapel Hill

Beverly W. Armstrong, M.D., 106 W. 7th
Street, Charlotte 2

John R. Ashe, Jr., M.D., 624-A. N. Church
Street, Concord

Horace M. Baker, Jr., M.D., Medical Arts
Building, Lumberton

Samuel R. Cozart, M.D., 122 S. Green Street,
Greensboro

D. LeRoy Crandell, M.D., Bowman Gray,
Winston-Salem

Joseph S. Hiatt, Jr., M.D., 208 S. W. Broad
Street, Southern Pines

John R. Hoskins, III, M.D., 203 Doctors
Bldg., Asheville

Will Camp Sealy, M.D., Duke Hospital, Dur-
ham

Charles R. Stephen, M.D., Box 3535, Duke
Hospital, Durham

Thomas B. Wilson, M.D., Rex Hospital
Laboratory, Raleigh

Committee on Arrangements (3) — (plus 3
consultants) III-l

John S. Rhodes, M.D., Chairman, 700 W.
Morgan Street, Raleigh

Theodore S. Raiford, M.D., 301 Doctors Bldg.,
Asheville

Walter Spaeth, M.D., 116 South Road Street,
Elizabeth City

George Gilbert, M.D., Consultant, 309 Doc-
tors Bldg., Asheville

Robert S. Roberson, M.D., Consultant, 102
Brown Avenue, Hazelwood

Jack C. Homer, M.D., Consultant, 119 Hos-
pital Drive, Spruce Pine

Committee on Scientific Audio-Visual

Postgraduate Instruction (10) III-2

J. Leonard Goldner, M.D., Chairman, Duke
Hospital, Durham

Lenox D. Baker, M.D., Duke Hospital, Dur-
ham

H. Frank Starr, M.D., Pilot Life Insurance
Company, Greensboro

Gordon M. Carver, Jr., M.D., 1203 Broad

Street, Durham

Joseph F. McGowan, M.D., 200 New Medical
Bldg., Asheville

C. Glenn Sawyer, M.D., Bowman Gray, Win-
ston-Salem

L. Everett Sawyer, M.D., 104 W. Colonial
Avenue, Elizabeth City

J. O. Williams. M.D., Cabarrus Memorial Hos-
pital, Concord

George T. Wolff, M.D., Co-Chairman, 135
Bishop Street, Greensboro

Warner L. Wells, M.D., N. C. Memorial Hos-
pital, Chapel Hill

Committee on Scientific Awards (10) II 1-3
(to be announced in Fall)

9.

Committee on Scientific Works (III-7) (5)-
(plus Section Chairmen as Consultants)

Wm. McN. Nicholson, M.D., Chairman, Duke
Hospital, Durham

Hubert McN. Poteat, Jr., M.D., 713 Wilkins
Street, Smithfield

Paul F. Maness, M.D., 328 W. Davis Street,
Burlington

George M. Cooper, Jr., M.D., 2111 Clark
Avenue, Raleigh

George T. Wolff, M.D., 135 Bishop Street,
Greensboro

Consultants: (1960-1961 Section Chairmen)

Julius Sader, M.D. (Gen. Practice of Medi-
cine), 205 East Main Street, Brevard

Walter Spaeth, M.D. (Internal Medicine), 116
South Road Street, Elizabeth City

Charles W. Tillett, M.D., (Ophthal & Otol),
1511 Scott Avenue, Charlotte

James E. Davis, M.D. (Surgery), 1200 Broad
Street, Durham

Wm. W. Farley, M.D. (Pediatrics), 903 W.
Peace Street, Raleigh

Fleming Fuller, M.D., (Ob-Gyn), Kinston
Clinic, Kinston

Isa C. Grant, M.D. (Pub Health & Ed), 3006
Warren Ave., Raleigh

Myron G. Sandifer, M.D. (N&P), N. C.
Memorial Hospital, Chapel Hill

Roger W. Morrison, M.D. (Pathology), 65
Sunset Parkway, Asheville

Charles E. Whitcher, M.D. (Anesthesia),
300 Hawthorne Rd., Winston-Salem

Isadore Meschan, M.D. (Radiology), Bowman
Gray, Winston- Salem

Chalmers R. Carr, M.D. (Ortho & Trauma-
tology), 1822 Brunswick Avenue, Charlotte

Mr. John Feagin (Student AMA), Duke Uni-
versity School of Medicine, Durham

Committee on Blue Shield (9) II-3

Jacob H. Shuford, M.D., Chairman (1962),

7 Main Avenue Place, S. W., Hickory
W. Z. Bradford, M.D., (1961), 1509 Elizabeth

Avenue, Charlotte
Willard C. Goley, M.D. (1962), 214 N. Mar-
ket Street, Graham
William J. Cromartie, M.D. (1963), UNC

School of Medicine, Chapel Hill
John R. Hoskins, III, M.D. (1963), 203 Doc-
tors Bldg., Asheville
Julius A. Howell, M.D. (1961), Bowman Gray,

Winston-Salem
John W. Morris, M.D., (1962), 1707 Arendell

Street, Morehead City
E. Eugene Menefee, Jr., M.D. (1963), Duke

Hospital, Durham
Max P. Rogers, M.D. (1961), 624 Quaker

Lane, High Point
Committee Advisory to North Carolina State
Board of Public Welfare (9) VI-2
J. Street Brewer, M.D., Chairman, Box 98

Roseboro
Bruce B. Blackmon, M.D., Buies Creek
Stephen R. Bartlett, Jr., M.D., 1001 E. 4th

Street, Greenville
Allyn B. Choate, M.D., 1012 Kings Drive,

Charlotte 2
Clyde R. Hedrick, M.D., 104 North Main

Street, Lenoir
J. Kempton Jones, M.D., 1001 S. Hamilton

Road, Chapel Hill
B. Bruce Langdon, M.D., 903 Hay Street,

Fayetteville
Wm. Raney Stanford, M.D., 111 Corcoran

Street, Durham
David G. Welton, M.D., 718 Professional

Bldg., Charlotte 2

296

NORTH CAROLINA MEDICAL JOURNAL

July, I960

10. Committee on Cancer (12) (Legal — 1 each
Congressional District) VI-3

James F. Marshall, M.D., Chairman. 310 W.
4th Street, Winston-Salem

Wm. H. Bell. Jr., M.D. (3rd), P. O. Box 1580,
New Bern

Joshua F. B. Camblos, M.D. (12th), 500 New
Medical Bldg., Asheville

Charles I. Hams, Jr., M.D. (1st), Martin
General Hospital, Williamston

Arthur B. Bradsher, M.D. (6th), 1200 Broad
Street, Durham

Harry V. Hendrick, M.D. (11th), Rutherford
Hospital, Rutherfordton

Harold A. Peck, M.D. (8th), Moore Mem-
orial Hospital, Pinehurst

Charles Glenn Mock, M.D. (10th), 200 Haw-
thorne Lane, Charlotte

David L. Pressly, M.D. (9th), 1025 Davie
Street, Statesville

Samuel L. Parker, Jr., M.D. (2nd), Kinston
Clinic, Kinston

Hubert McN. Poteat, Jr., M.D. (4th), 713
Wilkins St., Smithfield

D. Ernest Ward, Jr., M.D. (7th), 304 .Med-
ical Arts Building, Lumberton

11. Committee on Child Health (9) VI-4
Angus M. McBryde, M.D., Chairman, 809 W.

Chapel Hill Street, Durham
P. J. McElrath, M.D., 500 St. Mary's Street,

Raleigh
Dan P. Boyette, Jr., M.D., 217 W. Main

Street, Ahoskie
Harrie R. Chamberlin, M.D., UNC School of

Medicine, Chapel Hill
Jean C. McAlister, M.D., 104 E. Northwood

Street, Greensboro
John W. Nance, M.D., 401 Cooper Drive,

Clinton
Wm. H. Patton, Jr., M.D., 305 College

Street, Morganton
Robert L. Vann, M.D., Bowman Gray, Win-
ston-Salem
Robert F. Poole, Jr., M.D., 817 Hillsboro

Street, Raleigh

12. Committee on Chronic Illness. Including
Tuberculosis and Heart Disease (15) VI-5
John R. Kernodle, M.D., Chairman, Kernodle

Clinic, Burlington

Stephen R. Bartlett, Jr., M.D., 1001 E. 4th
Street, Greenville

Robert H. Dovenmuehle, M.D., Duke Hospi-
tal, Durham

John D. Fitzgerald, M.D., 409 Roxboro Bldg.,
Roxboro

Robert L. Garrard, M.D., 800 North Elm
Street, Greensboro

O. David Garvin, M.D., Health Department,
Chapel Hill

Robert A. Gregg, M.D., Central Convalescent
Hospital, Greensboro

Emery T. Kraycirik, M.D., Box 1153, Bur-
lington

Daniel A. McLaurin, M.D., 118 Main Street,
Garner

Thomas R. Nichols, M.D., 206 N. Sterling
Morganton

Elbert L. Persons, M.D., Duke Hospital,
Durham

John L. Shirey, M.D., 1 Battle Square,
Asheville

George L. Verdone, M.D., 1012 Kings Drive,
Charlotte

Donald D. Weir, M.D , N. C. Memorial Hos-
pital, Chapel Hill

Wm. H. Flythe, M.D., 624 Quaker Lane,
High Point

13. Committee on Constitution and By-Laws
(5) II-4

Roscoe D. McMillan, M.D., Chairman, Box

232, Red Springs
Millard D. Hill, M.D., 15 W. Hargett Street,

Raleigh
Edward W. Schoenheit, M.D., 46 Haywood

Street, Asheville
G. Westbrook Murphy, M.D., 103 Doctors

Bldg., Asheville
Louis deS. Shaffner, M.D., 300 S. Hawthorne

Road, Winston-Salem

1 I. Committee on Medical Credit Bureaus (7)
II-5

W. Howard Wilson, M.D., Chairman, 403

Professional Bldg., Raleigh
Fred K. Garvey, M.D., Bowman Gray, Win-
ston-Salem
John R. Hoskins, III, M.D, 203 Doctors

Bldg., Asheville
Bob Lewis Fields, M.D., Professional Bldg.,

Salisbury
Lockert B. Mason, M.D., 1006 Murchison

Bldg., Wilmington
Ross S. McElwee, Jr., M.D., 1340 Romany

Road, Charlotte
Ralph J. Sykes, M.D., 205 Rawley Avenue,

Mt. Airy

15. Committee on Credentials of Delegates to
House of Delegates (5) III-4

T. Tilghman Herring, M.D., Chairman, Wil-
son Clinic, Wilson

Milton S. Clark, M.D., Wachovia Bank Bldg.,
Goldsboro

James E. Hemphill, M.D., 1012 Kings Drive,
Charlotte

Robert M. Whitley, M.D., 144 Coast Line
Street, Rocky Mount

Charles B. Wilkerson, M.D., 100 S. Boylan
Avenue, Raleigh

16. Committee on Emergency Medical and
Military Service (8) IV-1

George W. Paschal, Jr., M.D., Chairman,
1110 Wake Forest Road, Raleigh

Chauncey L. Royster, M.D. Co-Chairman, 707
W. Morgan Street, Raleigh

Zackary F. Long, M.D., 304 E. Washington
St., Rockingham

Leslie M. Morris, M.D., Medical Building,
Gastonia

H. Mack Pickard, M.D., 7 N. 17th Street,
Wilmington

Daniel N. Stewart, Jr., M.D., 3 Third Ave-
nue, N. W., Hickory

Hugh F. McManus, Jr., M.D., 722 St. Mary's
Street, Raleigh

George A. Watson, M.D., 306 S. Gregson
Street, Durham

17. Committee on Scientific Exhibits (7) III-5

Raphael W. Coonrad, M.D., Chairman, Broad

& Englewood Sts., Durham

Lenox D. Baker, M.D., Co-Chairman, Duke

Hospital, Durham
Wm. Henry Boyce, M.D., Bowman Gray,

Winston-Salem
Thomas B. Daniel, M.D., 700 W. Morgan

Street, Raleigh
Erie E. Peacock, Jr., M.D., N. C. Memorial

Hospital, Chapel Hill
O. Norris Smith, M.D., 1019 Professional

Village, Greensboro
Vernon H. Youngblood, M.D.. 609 Kannapo-

lis Highway, Concord

July, 1960

SCHEDULE OF COMMITTEE APPOINTMENTS

297

18. Committee on Eve Care and Eye Bank (8)
IV-2

George T. Noel, M.D., Chairman, 211

Raleigh Building, Kannapolis
Win. Banks Anderson, M.D., Box 3802, Duke

Hospital, Durham
Horace M. Dalton, M.D., 400 Glenwood Ave-
nue, Kinston
Louten R. Hedgpeth, M.D., Medical Arts

Building, Lumberton
George Levi, M.D., 802 Glenwood Drive,

Fayette ville
Edward E. Moore, M.D., 706 Flatiron Bldg.,

Asheville
J. David Stratton, M.D., 1012 Kings Drive,

Charlotte
George T. Thornhill, M.D., 720 W. Jones

Street, Raleigh

19. Committee on Finance (3) plus consultants
1-1

Wayne J. Benton, M.D., Chairman, 2320
Battleground Road, Greensboro

Lenox D. Baker, M.D., Duke Hospital, Dur-
ham

Arthur L. Daughtridge, M.D., Box 111,
Rocky Mount

Alexander Webb, Jr., M.D., Consultant, 231
Bryan Bldg., Raleigh

Graham B. Barefoot, M.D., Consultant. Box
1198, Wilmington

Newsom P. Battle, M.D., Consultant, 404
Falls Road, Rocky Mount

Isaac E. Harris, Jr., M.D., Consultant, 1200
Broad Street, Durham

Donald B. Koonce, M.D., Consultant, 408 N.
11th Street, Wilmington

Malory A. Pittman, M.D., Consultant, Wil-
son Clinic, Wilson

James P. Rousseau, M.D., Consultant, 1014
West Fifth Street, Winston-Salem

O. Norris Smith, M.D., Consultant, 1019 Pro-
fessional Village, Greensboro

Edward W. Schoenheit, M.D., Consultant. 46
Haywood Street, Asheville

John C. Reece, M.D., Consultant, Grace
Hospital, Morganton

A. Hewitt Rose, Jr., M.D., Consultant, 2009
Clark Avenue, Raleigh

20. Committee on Grievances (5) (1st Five Past
Presidents) VIII-0

James P. Rousseau, M.D., Chairman, 1014
West Fifth Street, Winston-Salem

John C. Reece, M.D., Secretary, Grace Hos-
pital, Morganton

Lenox D. Baker, M.D., Duke Hospital, Dur-
ham

Edward W. Schoenheit, M.D., 46 Haywood
Street, Asheville

Donald B. Koonce, M.D., 408 N. 11th Street,
Wilmington

21. Committee on Medical Golf Tournament
(3) III-6

Wm. A. Brewton, M.D., Chairman, 5 Lake

Drive, Enka
Ralph B. Garrison, M.D., 222 N. Main Street,

Hamlet
Charles W. Styron, M.D., 615 St. Mary's

Street, Raleigh

22. Committee on Hospital and Professional
Relations and Liaison to North Carolina
Hospital Association (10) V-l

Theodore H. Mees, M.D., Chairman (5th),
501 W. 27th Street, Lumberton

Quinton E. Cooke, M.D., (1st), 209 E. Main
Street, Murfreesboro

Paul McNeely Deaton, M.D., (9th), 766 Hart-
ness Road, Statesville

John Tyler Dees, M.D., (3rd), Box 248, Bur-

gaw
Frederick C. Hubbard, M.D. (8th), Box 30,

North Wilkesboro
H. Lee Large, Jr., M.D. (7th), Presbyterian

Hospital, Charlotte
Arthur H. London, Jr., M.D. (6th), 306 S.

Gregson Street, Durham
Wm. A. Farmer, M.D. (2nd), 103 Davis

Street, Fayetteville
James S. Raper, M.D. (10th), Doctors Build-
ing, Asheville
Jack W. Wilkerson, M.D. (4th), Community

Clinic, Stantonsburg

23. Committee to Work with North Carolina
Industrial Commission (6) II-6

Thomas B. Dameron, Jr., M.D., Chairman,
1313 Daniels Street, Raleigh

Wm. F. Hollister, M.D., Moore County Hospi-
tal, Pinehurst

James S. Mitchener, Jr., M.D., Scotland
County Memorial Hospital, Laurinburg

Guv L. Odom, M.D., Duke Hospital, Durham

Malory A. Pittman, M.D., Wilson Clinic
Wilson

Charles T. Wilkinson, M.D., 205 Waite Street,
Wake Forest

24. Committee on Insurances (7) IV-3

Joseph W. Hooper, Jr., M.D., Chairman, 110
N. 11th Street, Wilmington

Robert H. Brashear, Jr., M.D., N. C. Mem-
orial Hospital, Chapel Hill

John C. Burwell, Jr., M.D., 1026 Professional
Village, Greensboro

Barry F. Hawkins, M.D., Ardsley Road, Con-
cord

Alban Papineau, M.D., Plymouth Clinic, Ply-
mouth

Henry B. Perry, Jr., M.D., 344 North Elm
Street, Greensboro

S. Glenn Wilson, M.D., Box 158, Angier

25. Committee on Legislation (3 members plus
President & Secretary) 10 Consultants) V-2
Hubert McN. Poteat, Jr., M.D.. Chairman-

(National), 713 Wilkins Street, Smithfield
Lenox D. Baker, M.D., Duke Hospital, Durham
Edgar T. Beddingfield, Jr., M.D., Co-Chair-

man-( State), P. O. 137, Stantonsburg
Amos N. Johnson, M.D., President (Ex Offi-
cio), Garland
John S. Rhodes, M.D., Secretary (Ex Officio),

700 W. Morgan Street, Raleigh
Daniel S. Currie, Jr., M.D. (Consultant), 111

Bradford Avenue, Fayetteville
Joseph S. Holbrook, M.D., (Consultant),

Davis Hospital, Statesville
Wm. E. Keiter, M.D. (Consultant) 400 Glen-
wood Avenue, Kinston
Donald B. Koonce, M.D. (Consultant), 408 N.

11th Street, Wilmington
Leslie M. Morris, M.D. (Consultant), Med-

ica Building, Gastonia
Zack D. Owens, M.D. (Consultant), Medical

Building, Elizabeth City
Robert Stuart Roberson, M.D. (Consultant),

102 Brown Avenue, Hazelwood
James P. Rousseau, M.D. (Consultant) 1014

West Fifth Street, Winston-Salem
Ben F. Royal, M.D. (Consultant), 907 Evans

Street, Morehead City
Thomas B. Dameron, Jr., M.D. (Consultant),

1313 Daniels Street, Raleigh
26. Committee on Maternal Health (14) VI-6

James F Donnelly, M.D., Chairman (1966).

State Board of* Health, Raleigh
W. Joseph May, M.D., Secretary (8th), 121

Professional Bldg., Winston-Salem

298

NORTH CAROLINA MEDICAL JOURNAL

July. 1960

Glenn E. Best, M.D., (3rd)-(1966), Main

Street, Clinton
Jesse Caldwell, Jr., M.D., (7th)-(1961), 114

West Third Street, Gastonia
P. J. McElrath, M.D. (6th)-(1961), 500 St.

Mary's Street, Raleigh
Milton' S. Clark, M.D. (4th)-(1961), Wacho-
via Bank Bids'., Goldsboro
W. Otis Duck, M.D. (10th)-(1963), Box 387,

Mars Hill
Wm. A. Hoggard, Jr., M.D. (lst)-(1965),

1502 Carolina Avenue. Elizabeth City
Wm. R. Wellborn, Jr., M.D. (9th)-(1964), 222

W. Union Street, Morganton
Frank R. Lock, M.D. (BG)-(1965), 300 S.

Hawthorne Road, Winston-Salem
Hugh A. McAllister, M.D. (5th)-(1965), 27th

at Barker St., Lumberton
Roy T. Parker, M.D. (Duke)-(1966), Box

3517, Duke Hospital, Durham
Robert A. Ross, M.D. (UNC)-(1963), N. C.

Memorial Hospital, Chapel Hill
H. Fleming Fuller, M.D. (2nd)-(1963), Kin-

ston Clinic, Kinston

27. Medical-Legal Committee (7) V-3

Julius A. Howell, M.D., Chairman, Bowman
Gray, Winston-Salem

Theodore S. Raiford. M.D., 301 Doctors
Bldg., Asheville

David G. Weiton, M.D., 403 N. Tryon Street,
Charlotte

John W. Foster, M.D., Veterans Administra-
tion, Winston-Salem

Connell G. Garrenton, M.D.. Bethel Clinic,
Bethel

June U. Gunter, M.D., Watts Hospital, Dur-
ham

Bennette B. Pool, M.D., 414 Nissen Building,
Winston-Salem

2S Committee on Medical Care Armed Forces
Dependents ("MEDICARE") (13) (plus
Subcommittee Consultants — 19) II-7

David M. Cogdell, M.D., Chairman. 911 Hay

Street, Fayetteville
George A. Watson, M.D., 306 S. Gregson

Street, Durham
Wm. H. Breeden, M.D., 1606 Morganton

Road, Favetteville
Everett I. Bugg, Jr., M.D., Broad and Engle-

wojd Sts., Durham
Jesse Caldwell, Jr., M.D.. 114 W. Third

Street, Gastonia
Daniel S. Currie, Jr., M.D., 111 Bradford

Avenue, Favetteville
Powell G. Fox, M.D., 1110 Wake Forest
Road, Raleigh

Wm. F. Hollister, M.D., Moore County Hos-
pital, Pinehurst
Donald B. Koonce, M.D., 408 N. 11th Street,

Wilmington
J. Douglas McRee, M.D., 2109 Clark Avenue,

Raleigh
Vernon L. Andrews, M.D., Box 407, Mt. Gilead
A. Ledyard DeCamp, M.D., 1505 Elizabeth

Avenue, Charlotte
Donald H. Vollmer, M.D., 403 Doctors Bldg.,

Asheville
A. — General Medicine

John L. McCain, M.D., Chairman, Wilson

Clinic, Wilson
B. Joseph Christian, M.D., 948 Walker

Avenue, Greensboro
Leonard E. Fields, M.D., Box 788, Chapel

Hill
Joseph M. Hitch, M.D., 415 Professional
Bldg., Raleigh

B. — Radiology

James E. Hemphill, M.D., Chairman,
1012 Kings Drive, Charlotte

Joe Lee Frank, Jr., M.D.. Roanoke-
Chowan Hospital, Ahoskie
C. — Surgery

Wayne H. Stockdale, M.D., Chairman,
703 North Street, Smithfield

Howard M. Ausherman, M.D., 200 Haw-
thorne Lane, Charlotte

Fred K. Garvey, M.D., Bowman Gray,
Winston-Salem

George R. Miller, M.D., 412 Realty Bldg.,
Gastonia

Guy L. Odom, M.D.. Duke Hospital, Dur-
ham

C. F. Siewers, M.D., 201 Churchill Drive,
Favetteville

Larry Turner, M.D., 1110 W. Main
Street, Durham
D. — Obstetrics & Gynecology

John C. Burwell, Jr., M.D., Chairman,
1026 Professional Village, Greensboro

R. Vernon Jeter, M.D., Plymouth Clinic,
Plymouth

Trogler F. Adkins, M.D., 306 S. Gregson
Street, Durham
E. — Pediatrics

Dan P. Boyette, Jr., M.D., Chairman, 217
W. Main Street, Ahoskie

Robert F. Poole, Jr., M.D., 817 Hillsboro
Street, Raleigh

George W. Kernodle. M.D., Medical Cen-
ter Pharmacy Bldg., Burlington

29. Committee on Menial Health (14) VI-7
Allyn B. Choate, M.D., Chairman, 1012 Kings

Drive, Charlotte

Wilmer C. Betts, Jr., M.D., 2109 Clark Ave-
nue, Raleigh

E. W. Busse, M.D., Duke Hospital, Durham

Milton S. Clark, M.D., Wachovia Bank Bldg.,
Goldsboro

James F. Elliott, M.D., State Hospital, But-
ner

John W. Ervin, M.D., Box 132, State Hos-
pital, Morganton

John A. Fowler, M.D., 2212 Erwin Road,
Durham

Thomas T. Jones, M.D., 604 W. Chapel Hill
Street, Durham

Hans Lowenbach, M.D., Duke Hospital, Dur-
ham

Phillip G. Nelson, M.D., 1211 Rock Spring
Road, Greenville

James T. Proctor, M.D., 428 Ridgefield Road,
Chapel Hill

Walter A. Sikes, M.D., State Hospital, Ral-
eigh

Joseph B. Stevens, M.D., 1017 Professional
Village, Greensboro

David A. Young, M.D., 714 St. Mary's Street,
Raleigh

30. Committee on Necrology (3) IV-4

Charles H. Pugh, M.D., Chairman, Box 527,

Gastonia
Charles T. Pace, M.D., Co-Chairman, 1802

Independence, Greensboro
Ben F. Royal, M.D., Box 628, Morehead City

31. Committee on Negotiations (3) IX-0

Wm. F. Hollister, M.D.. Chairman (term ex-
pires 1961), Moore County Hospital, Pine-
hurst
Theodore S. Raiford, M.D. (term expires

1963), 301 Doctors Bldg., Asheville
Hubert McN. Poteat, Jr., M.D. (term ex-
pires 1965), 713 Wilkins Street, Smith-
field

1960

SCHEDULE OF COMMITTEE APPOINTMENTS

299

35.

Chairman (9th) 7
W., Hickory
(7th), 114 W. Third

913 Murchison
Davis

140 S. W.

Bow-

Build-

Green-

Wilson

Doctors

32. Nominating Committee

Jacob H. Shuford, M.D.,
Main Avenue Place, S.
Jesse Caldwell, Jr., M.D.

Street, Gastonia
Robert M. Fales, M.D. (3rd).

Bldg., Wilmington
Paul F. Maness, M.D. (6th), 328 W.

Street, Burlington
Robert M. McMillan, M.D. (5th),

Broad Street, Southern Pines
Charles M. Norfleet, Jr., M.D. (8th)

man Gray, Winston-Salem
Zack D. Owens, M.D. (1st), Medical

ing, Elizabeth City
Karl B. Pace, M.D. (2nd), Box 620,

ville
Malory A. Pittman, M.D. (4th),

Clinic, Wilson
James S. Raper, M.D. (10th), 103
Bldg., Asheville
33. Committee of Physicians on Nursing (8) IV-5
Robert R. Cadmus, M.D., Chairman, N. C.

Memorial Hospital, Chapel Hill
Harry L. Brockmann, M.D., 624 Quaker

Lane, High Point
Badie T. Clark, M.D., Carolina General Hos-
pital, Wilson
James E. Davis, M.D., 1200 Broad Street,

Durham
Wm. D. James, Jr., M.D., Box 351, Hamlet
David T. Smith, M.D., Duke Hospital, Durham
Thomas J. Taylor, M.D.. 643 Roanoke Ave-
nue, Roanoke Rapids
Nursing and Nursing Education — Subcom-
mittee

Thomas J. Taylor, M.D., Chairman, 643 Ro-
anoke Avenue, Roanoke Rapids
Nursing Careers-Subcommittee
Andrew J. Crutchfield, M.D., Chairman, 610

W. Fifth Street, Winston-Salem
Improvement of the Care of the Patient-
Subcommittee
Harry L. Brockmann, M.D., Chairman, 624

Quaker Lane, High Point
David T. Smith, M.D., Duke Hospital, Durham

34. Committee on Occupational Health (9) VI-8

Harry L. Johnson, M.D., Chairman, Box

530, Elkin
B. F. Cozart

Reidsville
B. Joseph Christian

nue, Greensboro
Mac Roy Gasque, M.D., Pisgah Forest
W. B. Townsend, M.D., Box 420, Charlotte
T. Beddingfield, Jr., M.D.,
Stantonsburg

M.D., 1116 S. Main Street,
M.D., 948 Walker Ave-

P. O. Box

M.D., 307 Woodburn

M.D., N. C
Chapel Hill
M.D

Memorial

Edgar

137,
James Kent Rhodes,

Rd., Raleigh
Wm. P. Richardson,

Hospital. Box 758,
Logan T. Robertson,

Street, Asheville

Committee on Postgraduate
(8) IV-6

Samuel L. Parker, Jr., M.D...

ston Clinic, Kinston
Wayne J. Benton, M.D.. 2320

Rd., Greensboro
Richard C. Proctor, M.D., Bowman Gray,

Winston-Salem
W. Otis Duck, M.D., Box 387, Mars Hill
Joseph A. Isenhower, M.D., 17 2nd Avenue,

N. E., Hickory
Wm. McN. Nicholson, M.D., Duke Hospital,

Durham

17 Charlotte

Medical Study

Chairman, Kin-
Battleground

36.

37

Frank R. Reynolds, M.D., 1613 Dock Street,
Wilmington „ „ ,, . ,

Wm. P. Richardson, M.D., N. C. Memorial
Hospital, Chapel Hill

Committee on Poliomyelitis (14) VI-9

Samuel F. Raveuel, M.D., Chairman, 104 t.
Northwood Street, Greensboro

Jay M. Arena, M.D., 1410 Duke University
Road, Durham , _ .. .,

Edward P. Benbow, Jr., M.D., 104 E. North-
wood Street, Greensboro

John W. Varner, M.D., Box 522, Lexington
Charles R. Bugg, M.D., 627 W. Jones Street,

Ralp^ B. Garrison, M.D., 222 N. Main Street,

Hamlet .

Wm. F. Harrell, Jr., M.D., Guaranty Bank

Bldg., Elizabeth City
Richard S. Kelly, M.D., 1606 Morganton

Road, Fayetteville
Donald B. Koonce, M.D., 408 N. 11th Street,

Wilmington _r„

Robert C. Pope, M.D., Wilson Clinic. Wilson
Fiank H. Richardson, M.D., Children's Clinic,

Black Mountain

Box BB, Marshall
M.D., 301 W. End Ave-

38.

M.D, Halifax County
Halifax
Relations (3) (7 Dis-

M.D., Chairman,
137, Stantonsburg
(5th) (1961), 222

Wm. A. Sams, M.D.,
Wm. G. Spencer. Jr.,

nue, Wilson
Robert F. Young,

Health Department,

Committee on Public
trict Consultants) V-4

Edgar T. Beddingfield, Jr.

(4th) (1962), P. O. Box
Ralph B. Garrison, M.D.

N. Main Street, Hamlet
Courtney D. Egerton, M.D. (6th) (1963), 714

St. Mary's Street, Raleigh
Stephen R. Bartlett, Jr., M.D. (2nd) (consul-
tant), 1001 E. 4th Street, Greenville
Glenn E. Best, M.D., (3rd) (consultant),

Main Street, Clinton
Wm. H. Bureh, M.D., (10th) (consultant),

Valley Clinic & Hospital, Bat Cave
Joseph S. Holbrook, M.D., (9th) (consultant).

Davis Hospital, Statesville
Fred K. Garvey, M.D. (8th) (consultant),

Bowman Grav, Winston-Salem
Walter Spaeth, M.D. (1st) (consultant), 116

South Road Street, Elizabeth City
David G. Welton, M.D. (7th) (consultant),

403 N. Tryon Street, Charlotte
Committee on Physical Rehabilitation (8)

George W. Holmes, M.D., Chairman, 2240
Cloverdale Avenue, Winston-Salem
Charles H. Ashford, M.D., 603 Pollock Street,

New Bern
F P. Dale, M.D., Kinston Clinic, Kinston
J. Leonard Goldner, M.D., Duke Hospital,

M.D-

1313 Daniels
N.
M.D., 123 N.
M.D., 405

Center
Second
Colony

39.

Durham
Walter S. Hunt,

Street, Raleigh
John Hays Rosser. M.D., 222

Street, Statesville
Marion B. Pate, Ji .

Street, St. Pauls
George H. Wadsworth,

Avenue, Ahoskie
Committee on Rural Health and General
Practitioner Award (9) V-5
R. Vernon Jeter, M.D., Chairman, Plymouth

Clinic, Plymouth
Philip E. Dewees, M.D., Box 217, Sylva
Vernon W Taylor, Jr., M.D., 815 N. Bridge

St., Elkin

.••Slid

NORTH CAROLINA MEDICAL JOURNAL

July. 1960

J. O. Williams. M.D., Cabarrus County Hos-
pital, Concord

George T. Wolff, M.D., 135 Bishop Street,
Greensboro

Charles T. Wilkinson. M.D., 209 Wilkinson
Bldf?., Wake Forest

Edward L. Bovette, M.D , Kenansville

W. E. Swain, M.D., 201 E. 5th Street, Wash-
ington

John T. Dees, M.D., Box 248, Burgaw

10. Committee on School Health and State
Coordinating Service (9) VI-11

Irma C. Henderson Smathers, M.D., Chair-
man, 1295 Merrimon Avenue, AsheviUe
Bruce B. Blackmon, M.D., Buies Creek
Jean Davidson Craven, M.D., 19 W. 3rd Ave-
nue, Lexington
Charles H. Gay, M.D., 1012 Kings Drive,

Charlotte 7
Wm. C. Hunter, M.D., 103 Pine Street, Wil-
son
Floyd L. Knight. M.D , 103 Hillcrest Drive,

Sanford
Joseph S. Bower, M.D., Box 12, Pink Hill
Robert C. Pope, M.D., Wilson Clinic, Wilson
Wm. T. Rainey, Si\, M.D., Highsmith Hos-
pital, Fayetteville

11. Committee Advisory to Student A.M. A.
Chapters in North Carolina (8) II-8

John P. Davis, M.D., Chairman, 821 Nissen

Bldg., Winston-Salem
Edgar T. Beddingfield, Jr., M.D., P. O. Box

137, Stantonsburg
Charles G. Young, M.D., 135 Bishop Street,

Greensboro
Isaac E. Harris, Jr., M.D., 1200 Broad Street,

Durham
John W. Nance, M.D., Main Street, Clinton
Robert A. Ross, M.D. (UNC Consultant), N.

C. Memorial Hospital, Chapel Hill
Wm. P. J. Peete, M.D. (Duke Consultant),

Duke Hospital, Durham
Robert L. McMillan, M.D. (BG Consultant),

Bowman Gray, Winston-Salem

42. Committee on Veterans Affairs (9) VI-12
Samuel L. Elfmon, M.D., Chairman, 225

Green Street, Fayetteville
Vernon L. Andrews, M.D., Box 407 Mt. Gi-

lead
Wilmer C. Betts, M.D., 2109 Clark Avenue,

Raleigh
H. Francis Forsyth, M.D., Bowman Gray,

Winston-Salem
David L. Phillips, M.D., 110 Oak Avenue,

Spruce Pine
James D. Piver, M.D., 209 Bayshore Blvd.,

Jacksonville
R. W. Postlethwait, M.D., VA Hospital, Dur-
ham
John T. Session^ Jr., M.D.. UNC Dapt. ot

Medicine, Chapel Hill
Charles R. Welfare, M.D., Professional 3idg.,

Winston-Salem

43. Insurc-nce Industrv Liaison Committee
(10) V-f

Frank W. Jones, M.D., Chairman, Catawba
Hospital, Newton

Jack E. Mohr, M.D., Acting Chairman, Med-
ical Arts Building, Lumberton

Grover C. Bolin, Jr., M.D., Box 120, Smith-
field

Andrew J. Dickerson, M.D., 1600 N. Main
Street, Waynesville

Archie Y. Eagles, M.D., 407 Colony Avenue,
Ahoskie

Cleon W. Goodwin. M.D., Wilson Clinic, Wil-
son

Charles I. Harris, Jr., M.D., Martin General
Hospital, Williamston

Barry F. Hawkins, M.D., Ardsley Road, Con-
cord

James R. Wright, M.D., 604 Professional
Bldg., Raleigh

George T. Wolff, M.D., 135 Bishop Street,
Greensboro

II. Committee Liaison to Study Integration of
Negro Physicians into Medici Society of
State of North Carolina (7) 1-2
J. Street Brewer, M.D., Chairman, P. O. Box

98, Roseboro
Paul F. Whitaker, M.D., 1205 N. Queen

Street, Kinston
Ben F. Royal, M.D., 900 Shepherd Street,

Morehead City
James P. Rousseau, M.D., 1014 West Fifth

Street, Winston-Salem
Joseph W. Hooper, Jr., M.D., 410 N. 11th

Street, Wilmington
James E. Hemphill, M.D., 1012 Kings Drive,

Charlotte 7
Henry B. Perry, Jr., M.D., 344 North Elm

Street, Greensboro

BULLETIN BOARD

COMING MEETINGS

North Carolina Urological Association, Annual
Meeting — Greystone Inn, Roaring Gap, September
25-26.

North Carolina Fifth District Medical Society
Meeting — Mid Pines Club, Pinehurst, October 5.

Eleventh Annual Winston-Salem Heart Sympo-
sium— Robert E. Lee Hotel, Winston-Salem, Octo-
ber 7.

Congress on Industrial Health — Hotel Charlotte,
Charlotte, October 10-12.

Duke University Medical Postgraduate Seminar
Cruise to the West Indies — November 9-18.

North Carolina Academy of General Practice,
Annual Meeting — Carolina Hotel, Pinehurst, No-
vember 27-30.

Fifth International Congress on Nutrition —
Sheraton Park and Shoreham Hotels, Washington,
D.C., September 1-7.

Southern Trudeau Society and Southern Tuber-
culosis Society Meeting — Hotel Francis Marion,
Charleston, South Carolina, Saptember 14-16.

American Rhinologic Society, Sixth Annual Aleet-

ing — Belmont Hotel, Chicago, October 8.

American College of Surgeons, Forty-sixth An-
nual Clinical Congress — San Francisco, October
10-14.

Inter-state Post-graduate Association, Forty-
fifth Scientific Assembly — Pittsburgh, October 31-
November 3.

Julv, 1960

BULLETIN BOARD

301

News Notes from the Duke University
Medical Center

A Duke University medical postgraduate sem-
inar cruise to the Virgin Islands and Puerto Rico
has been scheduled for next November.

Plans for the cruise were announced by Dr.
William M. Nicholson, assistant dean of the Duke
Medical School in charge of postgraduate educa-
tion. This cruise will replace one which has been
scheduled for the Baltic area in June and which
was cancelled, Dr. Nicholson said.

Purpose of the medical cruises is to enable phy-
sicians to combine postgraduate education with
vacation travel. Lectures by Duke Medical Center
faculty members are given aboard ship during
the cruises.

Physicians participating in the Virgin Islands
cruise will sail from New York aboard the Swed-
ish American Motorlines Kungsholm on November
9. Stops will be made at St. John and St. Thomas
in the Virgin Islands and at San Juan, Puerto
Rico. The cruise will terminate at New York on
November 18.

Serving on the shipboard faculty will be Dr.
Edwin P. Alyea, professor of urology; Dr. Nichol-
son, professor of medicine; Dr. Elbert L. Persons,
professor of medicine; Dr. William W. Shingleton,
professor of surgery; and Dr. Doris A. Howell,
associate professor of pediatrics.

The lectures will deal with subjects that include
thyroid abnormalities, chemical treatment of can-
cer, arthritis, diabetes, and blood disease. The pro-
gram will provide 30 hours of Category I, Post-
graduate Education, required by the American
Academy of General Practice.

Information concerning the cruise may be ob-
tained by writing to the Director of Postgraduate
Education, Duke University Medical Center, Dur-
ham, North Carolina.

* * *

A study aimed at the establishment of an In-
stitute on Continued Patient Care has been
launched at the Duke University Medical Center.

Currently being evaluated by State public health
officials, welfare leaders and others, the proposed
institute would provide an educational program
for workers in various health fields. Purpose of
the program would be to mobilize and coordinate
health services that are available to patients after
their discharge from hospitals.

David P. Henry, Duke Medical Center rehabili-
tation coordinator who presided at a meeting held
here to discuss the possibility of such a program,
said that hospital patients are often unable to re-
turn home when their condition permits discharge
simply because no resources are readily available
for the special home care that is required for
them.

In addition to local physicians, health personnel
such as nurses, physical therapists, welfare workers
and vocational rehabilitation counselors play im-

portant roles in the home care of a patient after
he leaves the hospital, Henry stated. Also, im-
portant contributions in this area can be made by
voluntary groups such as ministers civic clubs and
women's clubs, he said. A coordinated follow-up
program with clear-cut areas of responsibility
would enable all these groups and persons to
function effectively as a team.

Among persons attending the Duke meeting,
which was held to study the problem of follow-
up care and to obtain all possible information for
evaluation, were: Dr. Roy Norton, head of the
N. C. Department of Public Health; Dr. Ellen
Winston, head of the N. C. Department of Public
Welfare; Dr. Amos Johnson of Garland, president
of the N. C. Medical Society; William N. Ruffin of
Durham, former president of the National Assn.
of Manufacturers; Col. Charles Warren, director of
the N. C. Office of Vocational Rehabilitation; Dean
Edward McGavin of the University of North Car-
olina School of Public Health; Dr. David Garvin
of Chapel Hill, director of the Orange-Person-
Chatham County Health District; Dr. James H.
Semans, chairman of the Duke Medical Center's
rehabilitation committee; F. Ross Porter, director
of the Duke Medical Center Foundation; and Duke
Hospital superintendent Charles H. Frenzel.

Dean W. C. Davison of the Duke Medical School
pointed out that in addition to lightening the cost
of hospital care by permitting earlier discharges
of many patients, this program could make possi-
ble better care of the aged and chronically ill as

well as the patient just home from the hospital.
$ * $

The retiring dean of the Duke University School
of Medicine, Dr. W. C. Davison, has been elected
president of Alpha Omega Alpha, national Honor
Medical Society.

Dr. Davison, who retired as dean of the Duke
Medical School on July 1, will retire from the fac-
ulty in August, 1961. During his final year he
will continue as James B. Duke Professor of Pedi-
atrics.

In electing Dr. Davison to head the national
37,000-member body, the members of Alpha Omega
Alpha placed the Duke dean among a select group
of only five other persons who have been presi-
dent of the society during its 58-year history.

Dr. Davison, a member of the board of directors,
succeeds Dr. Walter Lawrence Bierring of Des
Moines, Iowa.

Other Alpha Omega Alpha officers include
Willard C. Rappleye of New York, vice-president;
and Josiah J. Moore of Chicago, secretary-
treasurer, both re-elected; and James A. Campbell,
who was named secretary-treasurer-elect.

How did the first man get to North America ?

In an attempt to solve the ancient riddle, a Duke
University research project has been launched
under the direction of Dr. Daniel A. Livingstone
of the Zoology Department faculty. A $25,600

302

NORTH CAROLINA MEDICAL JOURNAL

July, 1960

grant from the National Science Foundation will
support the work over the next two years.

Paul Colinvaux, Duke graduate student who is
assisting Dr. Livingstone, has just arrived in Alas-
ka. He will make care drillings to extract ma-
terials from land under the lakes.

After the materials are obtained, they will be
brought to Duke where they will be examined for
plant and animal microfossils, as well as for chem-
ical indications of past environment. Radioisotopic
techniques will be used.

The Duke researchers hope to find out whether
climatic conditions were the type which could have
allowed man to cross to this continent.

A new infant formula laboratory where some
800 baby bottles are prepared each day under
sterile conditions as exacting as those of an oper-
ating room has been open opened at Duke Hospi-
tal. The $45,000 facility replaces the previous
formula laboratory and is four times as large.

Mrs. A. H. Hampton, head nurse in the labora-
tory, said that the unit provides formula for in-
fants in the premature and newborn nurseries and
for those on medical and surgical wards. As many
as 25 different kinds and strengths of formula are
made up daily according to doctors' specifications.

Dr. Angus McBryde, professor of pediatrics, was
instrumental in planning the laboratory, which is
among the latest of a number of renovation pro-
jects at the Duke Medical Center.

News Notes from the University of
North Carolina School of Medicine

Awards and honors were announced by the Uni-
versity of North Carolina School of Medicine at
special exercises in honor of the 69 members of the
graduating class.

Dr. W. Reece Berryhill, dean of the school, pre-
sided over the program and Dr. Nathan Womack,
head of the Department of Surgery, was the prin-
cipal speaker. A brief address also was given by
James R. Harper of Chapel Hill, president of the
graduating class.

The American Medical Women's Association
Scholastic Award went to Margaret B. Scales of
Bay Shore, New York.

Robert B. Payne of Gastonia received the Deb-
orah C. Leary Memorial Award.

The Isaac H. Manning Award was presented to
Carwile LeRoy of Elizabeth City.

The Mosby Book Awards were received by Ro-
bert J. Cowan, Greensboro; Frederick D. Hamrick
III, Rutherfordton; Zebulon Weaver, III, Asheville;
Charles P. Eldridge, Jr., Raleigh and James R.
Harper of Chapel Hill.

The Roche Award went to William L. Black of
Charlotte.

Kenneth F. McCain of High Point and Carwile
LeRoy of Elizabeth City were given the Sheard-

Sanford Prizes of the American Society of Clin-
ical Pathologists.

The senior papers of 11 students were cited as
excellent and have been bound and placed in the
U.N.C. Division of Health Affairs Library.

These papers were written by William L. Black,
Charlotte; John R. Curtis, Bessemer City; Gerald
W. Fernald, Wilson; Carwile LeRoy. Elizabeth
City; Kenneth F. McCain, High Point; James M.
Marlowe, Walstonburg; William N. Mical, Cincin-
nati; Elwood E. Morgan, Burlington; Robert B.
Payne, Gastonia; William S. Pearson, Statesville,
and John C. Tayloe, Jr., of Washington.

A total of 17 other senior papers were cited as
being outstanding.

* * *

A number of faculty members of the University
of North Carolina School of Medicine participated
in the annual meeting of the American Medical
Association in Miami in June.

Drs. Richard L. Dobson and Donald C. Abelc of
the Department of Medicine, and D. M. Hale, a
research laboratory supervisor, presented a paper
on "The Effect of High and Low Salt Intake and
Repeated Episodes of Sweating on the Human
Endocrine Sweat Gland."

Dr. Charles H. Burnett, head of the Department
of Medicine, serves on the executive committee of
the Section of Experimental Medicine and Ther-
apeutics.

Drs. W. H. Akeson and D. S. Kellam prepared
an exhibit entitled "Congenital Kyphosis: The
Genesis of Microspondyly." Dr. Akeson is assistant
professor of surgery and Dr. Kellam is a former
resident in orthopedic surgery at N. C. Memorial
Hospital and is now with the Charlotte Memorial
Hospital.

* * *

The Home Savings and Loan Association of Dur-
ham and Chapel Hill has established scholarships
at the University of North Carolina School of
Medicine which will amount to $1,000 annually by
1963.

The first scholarship, for $250, will be awarded
to a first year medical student this fall and is re-
newable for the entire four years of medical study.
A similar award will be made each year to a stu-
dent of the incoming- class of the School of Medi-
cine. By 1963 four students will be receiving a
total of $1,000 annually.

The selection of the students for these scholar-
ships and the conditions of satisfactory perform-
ance necessary for annual renewal of them will be
determinsd by the School of Medicine.

In announcing the scholarship. Dr. William L.
Fleming, assistant dean of the School of Medicine,
explained that scholarships for medical schools
were of particular importance at the present time,
in view of the increasing need of physicians to
keep pace with the population growth of the na-
tion.

July, 1960

NORTH CAROLINA MEDICAL JOURNAL

303

Dr. Fleming said that the duration and cost of
medical training was much higher than in other
professional fields, making scholarships more
needed.

Dr. Colin G. Thomas, Jr., of the Department of
Surgery and Dr. John T. Sessions of the Depart-
ment of Medicine spoke before the annual meeting
of the Seaboard Medical Association at Nags Head
recently. Dr. Thomas talked on "The Timing and
Selection of Surgical Procedures in the Manage-
ment of Pancreatitis," and Dr. Sessions discussed
the topic, "Does Alcohol Damage the Liver When
Taken Before, After or Instead of Meals."

Dr. Ernest H. Wood, professor of radiology,
was elected vice president of the American Board
of Radiology at its annual trustee meeting in Cin-
cinnati. He has been a trustee of the board for
several years.

$ * *

A student of the University of North Carolina
School of Medicine will spend this summer work-
ing in a small, remote hospital in the Philippine
Islands.

Colonel D. Bessinger, Jr., of Asheville, who will
graduate from the U.N.C. School of Medicine next
June will spend the summer working in a small
remote hospital in the Philippines. His work will
be under the sponsorship of the Foreign Mission
Board of the Southern Baptist Convention. This
project is made possible by a grant of $1,985 from
the Smith, Kline and French Foreign Fellowship,
which is administered by the American Associa-
tion of Medical Colleges.

Working with physicians already practicing at
Mati, Bessinger will help with the public health
program and at the same time gain valuable clin-
ical experience. In addition, he will serve as a
"goodwill ambassador" representing American
medical schools in bringing the latest medical tech-
niques and procedures to remote hospitals and
clinics.

* * *

Dr. Judson J. Van Wyk, associate professor of
pediatrics will present three lectures in Europe
during June and July.

He will speak in Switzerland, England and Den-
mark and will also visit various endocrine clinics
in France, Germany and Holland.

Dr. Van Wyk will address the Zurich Kinder
Klinik in Zurich, Switzerland, on "Genetic Factors
in Staple Goiter."

He will speak before the Fourth International
Goiter Congress, which meets in London July 5-8.
This lecture also will deal with the inherited as-
pects of goiter.

Dr. Van Wyk will attend the First International
Endocrine Congress in Copenhagen, Denmark
July 18-23. Here he will lecture on "Syndrome of

Precocious Menstruation and Galactorrhea in Ju-
venile Hypothyroidism: An Example of Hormonal
Overlap in Pituitary Feedback."

Four psychiatrists of the staff of N. C. Mem-
orial Hospital of the University of North Carolina
have been cited for outstanding theses submitted
in connection with their three-year residency
training here.

They are Dr. J. Iverson Riddle, Morganton; Dr.
Rex Speers, Claremont; Dr. George Thrasher. Ro-
anoke, Virginia, and Dr. Andrew Briggs of Rich-
mond.

Dr. Riddle took first place and Dr. Speers was
awarded second place for the Anclote Manor Hos-
pital Prize. These awards were $150 and $50.

The title of Dr. Riddle's thesis was "Mental Sub-
normality: Its Place in Psychiatric Residency
Training Program." Dr. Speers' thesis was "Brief
Psychotherapy with College Women — Technique
and Criteria for Selection."

Dr. Thrasher and Dr. Briggs received honorable
mention for their theses.

The medical director of Anclote Manor Hospital
at Tarpon Springs, Florida, is Dr. Lorant Forizs,
former faculty member of the Department of Psy-
chiatry of the U.N.C. School of Medicine. The
awards were made here and Dr. Forizs was on
hand for the presentations.

The theses submitted by the four physicians
were required as a part of their specialized train-
ing in psychiatry. All four men completed their
training in June.

News Notes from the
Bowman Gray School of Medicine

Dr. C. C. Carpenter, dean of the Bowman Gray
School of Medicine, has announced that on July 1
Dr. William H. Boyce will assume his new duties
as director of the Section on Urology, Department
of Surgery. He will replace Dr. Fred K. Garvey.

Dr. Garvey, head of the section since 1941, will
continue as professor of urology on the full-time
faculty of the medical school and on the staff of
the urologic service of the North Carolina Baptist
Hospital.

Dr. Boyce, a graduate of Vanderbilt University
School of Medicine, completed his residency train-
ing in urology at the Cornell University Medical
Center and the University of Virginia Hospital be-
fore joining the faculty of the Bowman Gray
School of Medicine in 1952. He has made outstand-
ing- contributions in the field of research and has
contributed widely to the medical literature. He is
a member of the American Association of Genito-
urinary Surgeons, the American Board of Urology,
the Clinical Society of Genito-Urinary Surgeons
and the Society of University Surgeons.

304

NORTH CAROLINA MEDICAL JOURNAL

July, 19(50

Three new faculty appointments have been an-
nounced by the dean of the Bowman Gray School
of Medicine.

The appointments, effective July 1, are: Dr.
Henry S. Miller, instructor in internal medicine;
Dr. Herman E. Schmid, Jr., instructor in physiol-
ogy and pharmacology; and Dr. Robert P. Thomas,
instructor in ophthalmology.

Dr. Miller is a graduate of Bowman Gray
School of Medicine and has just finished his resi-
dency training in medicine here.

Dr. Schmid, a graduate of the University of
Chicago College of Medicine, interned at the Mil-
waukee County Hospital, Milwaukee, Wisconsin,
and served as a house physician at the Santa Cruz
County Hospital, Santa Cruz, California. He has
also served one year as administrator of the
Grants and Training Branch, National Heart In-
stitute, National Institutes of Health, Bethesda,
Maryland.

Dr. Thomas is a graduate of the University of
North Carolina School of Medicine and was en-
gaged in general practice for two years before
joining the house staff of the North Carolina Bap-
tist Hospital in 1957 as an assistant resident in
ophthalmology.

* * *

Dr. C. Hampton Mauzy, professor of obstetrics
and gynecology, has assumed supervision of ob-
stetrics at the medical school and the N. C. Bap-
tist Hospital under the chairmanship of Dr. Frank
R. Lock. This will enable Dr. Lock to devote more
of his time to the direct supervision of gynecologic
work. Dr. Mauzy joined the faculty of the medical
school in 1941.

Dr. Frank H. Hulcher, instructor in biochemis-
try, is engaged in work as i-esearch collaborator at
the Brookhaven National Laboratories, Upton.
Long Island, New York, for the months of June,
July and August.

Dr. Wingate M. Johnson, professor emeritus of
clinical internal medicine, presented a paper en-
titled, "Medical Care of Older Patients," at the
June meeting of the American Medical Associa-
tion at Miami Beach, Florida. Dr. Johnson is a
former trustee of the A.M. A. and an ex-officio
member of the House of Delegates. He is also on
the national and state committees for care of the
aged.

* * *
Dr. Howard H. Bradshaw, chairman of the De-
partment of Surgery, delivered the first Julian A.
Moore Memorial Lecture at the June meeting of
the Buncombe County Medical Society in Asheville.
The title of Dr. Bradshaw's talk was, "Advances
Made in Surgical Treatment of Pulmonary Tuber-
culosis."

On July 1, 101 doctors will begin house staff ap-
pointments at the North Carolina Baptist Hospital
and the Bowman Gray School of Medicine. Of the
total number, 68 doctors have served previous
residencies and internships here, and 33 are be-
ginning training here for the first time.

The new appointments are:

Anesthesiology: assistant resident — Dr. J. Rich-
ard R. Bobb.

Medicine: resident — Dr. Thomas N. Massey, Jr.;
assistant residents — Drs. Dean F. Gray, John D.
Hines, Phillip A. Sellers; interns — Drs. John D.
Bradley, Jr., Paul R. Brown, Milton S. Goldman,
James N. Hinson, George William Joyce, John
Scott Miller, Jr., Bernard S. Morse, and Isaiah J.
Seligman.

Neurosurgery: assistant resident — Dr. Trave L.
Brown, Jr.

Obstetrics and Gynecology: assistant residents
— Drs. Sam Jones Crawley, Jr. and Edward C.
Sutton.

Ophthalmology: assistant resident — Dr. Withrow
R. Legge, Jr.

Orthopaedics: assistant residents — Drs. Louis B.
Daniel, Jr. and Frank Sellers.

Otolaryngology: assistant resident — Dr. Robert
F. Thompson.

Pathology: assistant residents — Drs. William R.
Beach, III, Stephen Mamick, Modesto Scharyj,
and Franklin Bailey Wilkins; intern — Dr. Robert
E. Jones, Jr.

Pediatrics: assistant resident — Dr. Max Lassiter.

Radiology: assistant residents — Drs. James V.
Blazek, Ronald L. Kelly, Jr., and James L. Quinn,
III.

Surgery: assistant residents — Drs. W. Claude
Hollingsworth, William G. Montgomery, and Earl
P. Welch; intern — Dr. Tim Pennell.

Four new physicians have been appointed for
postdoctoral training as fellows. They are: Drs.
William B. Courtney, Fritz R. Dixon, and Sidney
Girsch, pathology; and Richard B. Patterson,
pediatric-hematology.

News Notes

Dr. C. A. Kimel has announced the opening of
his office for general practice at Ebert Street Ex-
tension and West Clemmonsville Road, Winston-
Salem.

EDGECOMBE-NASH MEDICAL SOCIETY

The monthly meeting of the Edgecombe-Nash
Medical Society was held in Rocky Mount on
June 8.

Dr. A. W. Hedgepeth, program chairman for
June, introduced the speaker, Dr. Paul Bunch, who
discussed pediatric surgery from a urologic stand-
point.

July, 1960

BULLETIN BOARD

305

Inter-State Post-Graduate Association

The Inter-State Post-Graduate Association will
hold its forty-fifth Scientific Assembly at the
Pittsburgh Hilton Hotel on October 31 to Novem-
ber 3. Pre-registration, accommodations, informa-
tion, and other communications may be addressed
to Mr. Roy T. Ragatz, Executive Director, at Box
1109, Madison 1, Wisconsin.

Twenty-one of the subjects are to be devoted to
subject of medicine, nine to surgery, one to radiol-
ogy, one to otolaryngology, and one to social ec-
onomics.

The program is approved for postgraduate edu-
cation, Category I, by the American Academy of
General Practice.

having programs in Chile. These included Catholic
Relief Service, Church World Service, CARE,
Seventh Day Adventists Welfare Service, and the
Church of Jesus Christ of Latter Day Saints.

As General Gruenther explained, "The impact of
voluntary contributions by individuals on the suf-
fering people of Chile will be tremendous."

In addition to the contributions of individuals,
tons of food, medical supplies, tents and other aid
were immediately airlifted to help the homeless
and the helpless. The American Red Cross and
numerous other organizations made emergency
allocations from their own funds and began to
campaign for funds and relief supplies for a long-
range program to help the people of Chile.

American Board of
Obstetrics and Gynecology

The next scheduled examination, (Part I), writ-
ten, will be held in various cities of the United
States, Canada, and military centers outside the
Continental United States, on Friday, January 13,
1961.

Candidates submitting applications in 1960 for
the 1961 examinations are not required to submit
case reports as previously required to complete
the Part I examinations of this Board. In lieu of
this requirement, new candidates are required to
keep in their files a duplicate list of hospital ad-
missions as submitted with their application, for
submittal at the annual meeting in Chicago should
they become eligible to take the Part II (oral) ex-
aminations.

Reopened candidates will be required to submit
case reports for review thirty days after notifica-
tion of eligibility. Scheduled Part I and candidates
resubmitting case reports are required to submit
Case Reports prior to August 1 each year.

Current bulletins may be obtained by writing to:
Robert L. Faulkner, M.D.
Executive Secretary and Treasurer
2105 Adelbert Road
Cleveland 6, Ohio

AMERICAN NATIONAL RED CROSS
The Chilean earthquake disaster, one of the
worst in modern times, has demonstrated again
the characteristic generosity of Americans toward
people in trouble.

Chile suffered this disaster during May, leaving
hundreds of thousands of Chileans cold, sick, in-
jured and homeless. Not only was emergency re-
lief needed but a long-range recovery program of
gigantic pi-oportions was necessary.

At President Eisenhower's request, General Al-
fred M. Gruenther, president of the American Red
Cross, became coordinator for voluntary Chilean re-
lief. Citizens were urged to make their contribu-
tions to the American Red Cross or other agencies

AMERICAN COLLEGE OF SURGEONS
Improvement in the total care of surgical pa-
tients will be the goal of 10,000 doctors expected
to attend the forty-sixth annual Clinical Congress
of the American College of Surgeons in San Fran-
cisco, California, October 10 through 14.

More than 1,000 participants will take part in
the various programs as authors of research re-
ports, teachers of postgraduate courses, partici-
pants in panel discussions, lecturers, and operating
surgeons in motion pictures and closed-circuit tele-
casts.

On the final evening, October 14, initiates will be
presented for fellowship, honorary fellowships con-
ferred, and officers inaugurated.

NATIONAL LEAGUE FOR NURSING INC.

Admissions to schools of professional and prac-
tical nursing reached an estimated 71,297 new
students in 1959, compared with 68,851 in 1958,
according to an announcement by Fred C. Foy,
chairman, Committee on Careers, National League
for Nursing, New York.

Professional nursing programs admitted 47,797
new students, a slight increase over the 47,351 ad-
missions of the preceding year. Practical nursing
schools enrolled an estimated 23,500 students in
1959, compared with 21,500 in 1958.

CATHOLIC HOSPITAL ASSOCIATION
Officers elected at the forty-fifth annual con-
vention of the Catholic Hospital Association of the
United States and Canada in Milwaukee, Wiscon-
sin, recently included The Rt. Rev. Msgr. A. W.
Jess, Camden, New Jersey, who took over the du-
ties of president from Father John J. Humensky,
Cleveland, Ohio. Sister M. Christine, C. C. V. I.,
of St. Joseph's Hospital, Houston, Texas, was
elected to represent the Southern section of the
United States, and Sister John Joseph, C.S.J., of
Santa Rosa Hospital, Santa Rosa, California, to
represent the Western section.

nut;

NORTH CAROLINA MEDICAL JOURNAL

July. 19G0

AMERICAN HEARING SOCIETY
Philip M. Morgan, industrialist, civic leader, and
philanthropist of Worcester, Massachusetts, was
re-elected president of the American Hearing So-
ciety at its forty-first annual conference in Detroit
(May 24-27), attended by professional workers in
the field of hearing and representatives of the
agency's lay membership from all pails of the
country. Program for the four-day meeting cen-
tered on the theme "Communication: Key to Liv-
ing."

Re-elected as officers of the society were: first
vice president — Miss Mary E. Switzer, director,
Office of Vocational Rehabilitation, Department of
Health, Education, and Welfare; second vice pres-
ident— James McKnight Timmons, M.D.; of Co-
lumbia, South Carolina, and treasurer — E. B.
Whitten, executive director of the National Re-
habilitation Association.

Biological Photographic Association Inc.

Photographers and scientists interested in the ap-
plication of new photographic techniques and
equipment in the field of biology will convene in
Salt Lake City, Utah, this summer for the
thirtieth annual meeting of Biological Photographic
Association. The meeting will be held August 23
through 26, with headquarters at the Hotel Utah
Motor Lodge.

AMERICAN GERIATRICS SOCIETY
The Willard 0. Thompson Memorial Award "for
distinguished contributions to geriatric medicine"
was presented to Dr. William B. Kountz of St.
Louis, Missouri, at the annual dinner of the Amer-
ican Geriatrics Society held recently at Miami
Beach.

Presentation of the award was made by Dr. Ed-
ward Henderson, chairman of the Society's Award
Committee and editor of the Journal of the Amer-
ican Geriatrics Society, on the occasion of the so-
ciety's seventeenth annual meeting. A professional
organization with a membership of more than
7,000 physicians, the society has as its purpose
encouraging and promoting the study of geriatrics.
The Willard O. Thompson Memorial Award, which
includes an honorarium and a medal, is given an-
nually to an outstanding specialist in geriatric
medicine.

BLUE SHIELD MEDICAL CARE PLANS
Chairman of the Board of the National Asso-
ciation of Blue Shield Plans, was named one of
three national civic leaders to receive the I960
"Health-USA" award sponsored jointly by the
Metropolitan Washington (D.C.) Board of Trade
and the Medical Society of the District of Colum-
bia. Dr. Stubbs, who has held important posts in
Blue Shield both at the local and national levels

adult

stable
diabetics

and a

significant

number of

sulfonylurea

failures
respond to

trademark,
brand of Phenformin HCI

adult stable diabetes

"In our experience the action of DBI on the adult stable
type of diabetes is impressive . . . 88% were well controlled
by DBI."i

"Most mild diabetic patients were well controlled on a
biguanide compound [DBI], and such control was occa-
sionally superior to that of insulin. This was true regardless
of age, duration of diabetes, or response to tolbutamide."2

"DBI has been able to replace insulin or other hypogly-
cemic agents with desirable regulation of the diabetes when
it is used in conjunction with diet in the management of
adult and otherwise stable diabetes."3

sulfonylurea failures

Among those diabetics who responded to tolbutamide ini-
tially and became secondary failures DBI "gave a satis-
factory response in 55%. "4

"DBI is capable of restoring control in a considerable por-
tion of patients in whom sulfonylurea compounds have
failed, either primarily or secondarily."5

"All twelve secondary tolbutamide failures have done well
on DBI."6

"34 out of 59 sulfonylurea primary failures were success-
fully treated with DBI."7

July, 1960

BULLETIN BOARD

307

during the past decade, was selected for ". . . . his
distinguished contributions to the health of the
American people." Dr. Stubbs received the "Health-
USA" award at a testimonial luncheon held in
Washington, D. C. on June 1. Present at the award
luncheon were Secretary Flemming, members of
Congress and medical leaders.

The two other recipients of the "Health-USA"
awards, which are given annually to recognize
"Statesmanship in Health," are Major General
Howard McC. Snyder, physician to the President of
the United States, and Elmer H. Bobst, Chairman
of the Board of Warner-Lambert Pharmaceutical
Company.

U. S. Department of
Health, Education, and Welfare

Douglas H. K. Lee, M.D., has been appointed
chief of the research headquarters of the Occu-
pational Health Program, Public Health Service,
U. S. Department of Health, Education, and Wel-
fare, at Cincinnati, Ohio. In his new position, Dr.
Lee will be responsible for directing technical re-
search and field studies of occupational health
problems and professional and technical consulta-
tion services to state agencies, labor, and industry.

Statement by Surgeon General Leroy E. Burney

Public Health Service scientists have been at-
tending the Second International Conference on
Poliomyelitis which has been meeting in Washing-
ton this week under the auspices of the World
Health Organization. During the past year our
staff have been following very closely the live
virus trials in various parts of the world. This
week, as a matter of fact, Dr. David E. Price, who
served as my personal representative at a series
of polio meetings in Moscow in mid-May, has
made public a report on the use of live virus in
the USSR during the past year.

I want to emphasize very strongly that the Pub-
lic Health Service and I, as Surgeon General, have
the responsibility for making sure that biological
products are safe and effective. We take that re-
sponsibility very seriously. When the technical ex-
perts of the National Institutes of Health and
their highly competent advisers are satisfied on
these two points, it will be possible to license a
live polio vaccine but not before. How soon that
will be, I do not know.

I should point out that, so far, only one manu-
facturer has applied for a license. This request
was returned for additional information; and no
applications are now pending.

In the meantime we have in the Salk vaccine a
proved and highly effective means for fighting

lowers
blood sugar

in mild,

moderate

and severe

diabetes,

in

children

not a sulfonylurea... DBI

(N1-(3-phenethylbiguanide) is
available as white, scored tablets of
25 mg. each, bottles of 100.

Send for brochure with complete dosage
instructions for each class of diabetes,
and other pertinent information.

1. Walker, R. S.: Brit. M. J. 2:405. 1959.

2. Odell, W. D., et al.: A.M. A. Arch. Int. Med.
102:520, 1958.

3. Pearlman, W.: Phenformin Symposium.
Houston, Feb. 1959.

4. DeLawter, D. E., et al.: J.A.M.A. 171:1786
(Nov. 28) 1959.

5. McKendry, J. B., et al.: Canad. M. A. J.
80:773, 1959.

6. Miller, E. C: Phenformin Symposium,
Houston, Feb. 1959.

7. Krall, L. P.: Applied Therapeutics 2:137, 1960.

an original development from the research
laboratories- of

u. s. vitamin & pharmaceutical corp.

Arlington-Funk Laboratories, division
250 East 43rd Street, New York 17, N. Y.

308

NORTH CAROLINA MEDICAL JOURNAL

July, 19K0

polio. It has been administered to about 80 million
Americans during the past five years, and, despite
a high polio incidence in the summer of 1950, it
has proved over 90 percent effective when the re-
commended course of injections is followed.

Unquestionably, a vaccine which can be admin-
istered orally and is less expensive to produce
would represent another major advance in the
fight against polio throughout the world.

We want to be very sure that it is entirely safe
and fully effective. When these two principles are
fully established by a qualified manufacturer, we
will be happy to grant licenses for its production.

United States Civil Service Commission

The Civil Service Commission has announced
the appointment of a five-man committee, repre-
senting the health insurance industry, to advise it
in connection with the government-wide indemnity
benefit plan, one of four types of health benefit
plans to be offered federal employees under the
new Federal Employees Health Benefits program.

Classified Advertisements

X-RAY Equipment for sale or exchange. 100 K.V.
100 M.A. Picker Radiographic unit with manual
operated tilt table combined with Fluoroscope
unit beneath the table. Provides instant change
over from Fluoroscopy to Radiography with spot
film device. Has had some use but is in excellent
working order also dark room equipment, mag-
netic type plate changer. Stereoscopic view boxes,
etc., will consider late model Ultra-violet lamp,
surgical endotherm in exchange. Write Box 790.
Raleigh, North Carolina.

AVAILABLE Desirable twelve hundred and fifty
square feet space suitable for doctors or dentist,
(iround floor Cameron Court apartments, corner
Snow and Morgan Streets, Raleigh. Air con-
ditioned, also heat, lights, water and parking.
On long lease will improve to suit tenant. Apply
A. W. Criddle, Manager, Temple 2-5395.

OPENINGS for psychiatrists, pediatricians and
general physicians for varied assignments with
North Carolina state hospitals and institutions
for retarded children. Several locations available.
Opportunity for all types of therapy, collabora-
tion or individual research in service training.
Medical school affiliations offers opportunity for
university appointment. Entire program operates
in close association with university program. Re-
tirement, Social Security, and other attractive
benefits including recent substantial increase in
salaries for psychiatrists, pediatricians and gen-
eral physicians. For particulars write Eugene
A. Hargrove, M.D., Commissioner of Mental
Health, P.O. Box 70, Raleigh, North Carolina.

DESIRABLE LOCATION for a physician. Contact
Godley Realty Company, Mt. Holly Road, Char-
lotte, North Carolina.

The Month in Washington

An omnibus bill approved by the House
Ways and Means Committee contains two
provisions of major importance to physi-
cians— Social Security coverage for doctors
and a federal-state program to provide
health care for older persons with low in-
comes.

About 150,000 self-employed physicians
would be covered by Social Security on the
same basis as lawyers, dentists and other
self-employed professional people now are
covered. Becoming effective for taxable
years ending on December 31, I960, or
June 30, 1961, self-employed physicians
would be required to pay a Social Security
tax of 4'o per cent of the first $4,800 of
income. Physicians also would be subject
to the automatic increases in the Social Se-
curity tax in future years.

Medical and dental interns would be
covered for the first time also.

Representative Wilbur Mills (D., Ark.),
Chairman of the Ways and Means Commit-
tee, was the main architect of the health
program for "medically indigent" aged. It
was designed to provide a broad range of
hospital, medical and nursing services for
persons 65 years of age and older who are I
able financially to take care of their ordin-
ary needs but not large medical expenses. I

It would be up to each state to decide
whether it participates in the program. The
extent of participation — the number of
benefits offered to older persons — also
would be at the option of individual states.

The states would determine the eligibility
of older persons to receive benefits under
the program. However, the legislation laid
down a general framework for eligibility;
persons 65 years and older, whose income
and resources — taking into account their
other living requirements — are insufficient
to meet the cost of their medical care.

The program couldn't become effective :
until July 1, 1961. Before putting such a
program into effect, a state would have ta
submit to the federal government a plan
meeting the general requirements outlined
in the legislation.

The program would be financed jointly
by the federal and state governments. Fed-
eral grants would have to be matched by
participating states on the same basis as

From Wrashingrton Office. American Medical Association
1523 L Street. N.W.

July, 1960

THE MONTH IN WASHINGTON

309

under the present-old age assistance formu-
la.

States could elect to provide, with federal
financial aid, any or all of the following
benefits: (1) Inpatient hospital services up
to 120 days per year; (2) skilled nursing-
home services; (3) physicians' services;
(4) outpatient hospital services; (5) or-
ganized home care services; (6) private
duty nursing services; (7) therapeutic
services; (8) major dental treatment; (9)
laboratory and x-ray services up to $200
per year, and (10) prescribed drugs up to
$200 per year.

The committee put a $325 million price
tag on the program for the first full year
of operation — $185 million federal and
$140 million state. This estimate, however,
could hardly be more than an educated
guess of sorts. The actual cost would de-
pend upon unpredictable factors — how
many states would participate, how many
benefits they would offer, and how many
older persons would qualify and what serv-
ices they would require.

The committee estimate was based on
between 500,000 and 1 million older per-
sons a year receiving health services under
the program. If all states participated
fully, the committee said, potential protec-
tion would be provided as many as 10 mil-
lion aged whose financial resources are so
limited that they would qualify in case of
serious or extensive illness.

Payments under the program would go
directly to physicians and other providers
of medical, hospital and nursing services.

In addition to the federal grants for the
"medically indigent," about $10 million
more in federal funds would be authorized
for payment to states for raising the stan-
dards of medical care benefits under pre-
sent public assistance programs for older
persons.

The approach of the Mills program was
similar to that of Point 2 of the American
Medical Association's 8-point program for
health care of the aged. Point 2 stated that
the A.M. A. supports federal grants-in-aid
to states "for the liberalization of existing
old-age assistance programs so that the
near-needy could be given health care with-
out having to meet the present rigid re-
quirements for indigency." Such a liberal-
ized definition of eligibility should be de-
termined locally, the A.M. A. said.

Approval of the Mills plan by the com-
mittee marked a sharp setback for organ-
ized labor leaders. But they continued their
all-out pressure campaign in an effort to
get Congressional approval of Forand-type
legislation that would use the Social Secur-
ity system to provide hospitalization and
medical care for the aged. After being de-
feated in the Ways and Means Committee,
labor union leaders and other supporters of
Forand-type legislation directed their ma-
jor efforts to trying to get the Senate to
substitute the Social Security approach.

The committee had been considering
health-care-for-the-aged legislation intermit-
tently for more than a year. Hearings were
held on the Forand bill last summer but
action was postponed until this year.
(CONTINUED ON PAGE 312)

BOOK REVIEWS

Biology of the Pleuropneumonialike Or-
ganisms. Annals of the New York Acad-
emy of Sciences, Vol. 79, Article 10, pages
305-758, 1960.
This publication of the New York Academy of
Sciences emphasizes the increasing- interest in the
pleuropneumonia group of organisms which here-
tofore have been of primary concern to taxonom-
ists and veterinary bacteriologists.

Contributions by 80 authors cover the present
state of knowledge concerning the morphology,
classification, isolation, cultivation, physiology,
serology, chemotherapy, and pathogenicity of the
pleuropneumonia group of organisms. It is fair to
say that more questions are raised than are an-
swered, but this only serves to indicate the need
for further investigations.

The important question of the pathogenicity of
the pleuropneumonia organisms for humans is not
completely answered. The isolation of PPLO from
approximately 70 per cent of more than 500 cases
of primary and recurrent nongonococcal urethritis
by Shepard would indicate more than a casual re-
lationship. Similar results have been obtained by
others when studying women with pelvic inflam-
matory disease and patients with acute hemor-
rhagic cystitis. The pathogenic capabilities are
not clear-cut, however, since PPLO can be isolated
from the genitourinary tracts of supposedly
normal males and females. As Dr. H. E. Morton
states on page 613: "Trying to relate PPLO to
disease is very difficult. However, when PPLO are
isolated in pure culture from the genito-urinary
tract in which there is pathology, and antibiotics
are given, and when, in 1 to 3 days the PPLO dis-
appear and the clinical symptoms begin to sub-
side, this is good circumstantial evidence that
PPLO were causing the pathology." Studies on

::io

NORTH CAROLINA MEDICAL JOURNAL

July, 19(30

PPLO-caused avian diseases have indicated that
a superimposed physiological stress may be a re-
quirement for the production of the disease state.
In addition to these important problems, the re-
lationship of PPLO and L forms of bacteria is
discussed. Of interest to those who are utilizing
tissue culture techniques in their research are the
discussions of the frequent contamination of cell
lines with PPLO.

This monograph will be especially useful to the
worker engaged in research in infectious diseases
and to the practitioner who is inquisitive about
current viral research and concepts.

Radiopaque Diagnostic Agents. Annals of

New York Academy of Sciences, Vol. 71,
Article 3, pages 705-1020, 1959.

This colloquium presents an extensive survey of
the past, present and possible future of radio-
graphic media. The first series of articles discuss
the historical development and the chemical and
pharmacologic properties of the common, pi-esent-
day media. Four articles describe experimental
work in animals with heavy metal chelates and
colloidal dispersions used as contrast agents. The
initial results were mixed and somewhat disap-
pointing. Excellent reviews of lymphadenography,
splenoportography with liver visualization, pan-
creatography, and radioisotopic liver and kidney
up-take studies are included.

Various clinical and technical aspects of modern
angiography are presented. Dr. J. Stauffer Leh-
man's evaluation of high concentrations of dia-
trizoate methyg^ucamine in angiography is par-
ticularly worthy of note. The effect of tempera-
ture, pre sure, and catheter size on speed of de-
livery of the commonly available medin is de-
scribed in two succinct graphs.

The last group of four articles deals with the
water soluble gastrointestinal contrast agents and
the newer contrast agent; for examination of the
genitourinary tract in a general fashion, citing
extensive clinical experience.

Virus Virulence and Pathogenicity. Ciba
Foundation Study Group No. 4. Edited by
G. E. N. Wolstenholme and Cecilia M.
O'Connor. Boston: Pubished by Little,
Brown, and Company, 1960.
During the past decade tremendous strides have
been made in our understanding of viruses and
their effects on the human host. From time to time
interested investigators must meet and discuss
problems of a general nature about which we know
less than is desirable. In the present monograph,
some of the leading virologists in the world met
to discuss the concept of virulence and pathogen-
icity of viruses.

In the introduction, pathogenicity is defined "as
the power to produce pathological affects in a host,
and virulence as the evidence of pathogenicity de-
rived from observation of the symptoms and
signs, degree of illness or death of the host."

During the course of the conference various
host-cell factors and human volunteer studies were
discussed.

A History of Neurology. By Walther
Rieser, M.D. 223 pages. Price, $4.00. New-
York: MD Publications, 1959.

The author begins his discussion of neurology
and its history with a consideration of various
functions of the nervous systems. The precedence
of structure to determine function, or function to
determine structure, is discussed at great length
in a somewhat theologic fashion. In like manner,
the platonic and other doctrines regarding the
soul are related to progress in neurology. Finally,
various philosophic concepts of cerebral localiza-
tion are presented.

Only passing mention is given to specific men
and important developments in neurology. Brief
reference is made to the development of ideas in
the treatment of neurologic disorders.

The book is printed neatly, free from typographic
errors, well indexed, and reasonably priced.

Although of interest to one concerned with the
evolution of philosophic concepts in neurology,
only the author's approach is presented. The book
would not serve as a source of reference.

Women and Fatigue by Marion Hilliard,
M.D., 175 pp., price $2.95, New York:
Doubleday and Company, Inc., 1960.
Women and Fatigue, a posthumous sequel to the
excellent A Woman Doctor Looks at Love and Mar-
riage, is both a source book for physicians whose
women patients ask, "Doctor, why am I so tired?",
and a manual of suggestions for such patients.
Chapter titles, such as "Fatigue Has Many
Faces", "Common Sense and Calories", and "The
Fallacy of the Shortcut to Vitality", indicate the
practical nature of the author's approach; while
titles such as "A Time To Be Born and a Time To
Die" and "Love God and Do As You Please" are a
guide to her philosophy. The simplicity of this
approach is, however, an insufficient indication of
the profundity of the thought and the breadth of
experience in helping women patients conquer
fatigue problems that is revealed in this small
volume.

Zest for living, throughout the entire life's
period is possible for women of all ages, married
or single, is the thesis which runs throughout this
book. Such zest comes from entering with verve
every open door that offers a genuine opportunity
As there is a time to be born and a time to die, so,
too, there is a time to be young and helpless, and
a time for growing up; a time for falling in love;
a time for growing older. Through meeting all ex-
periences of joy, suffering, sorrow, contentment,
achievement, and disappointment, the self develops
into a mature person in step with chronological
age.

July, 1960

BOOK REVIEWS

311

It was this reviewer's privilege to have our
second baby delivered by Dr. Hilliard. She was
not only herself a vital person, but one became
aware that through contact one's own revitaliza-
tion was taking place. Dr. Hilliard never married,
so she knew from personal experience the pro-
blems of the single woman in American society.
She looked at these unblinkingly, and supported
herself by such humor as "When night falls after
a long day of seeing patients, I sometimes have a
fanciful vision: all the married women are bitter-
ly thinking up ways to avoid making love, and all
the unmarried women are just dying to get at it"
(page 108).

Dr. Hilliard lived for a "cause": to get women
to work out an intellectual attack on their fatigue
problems, and by overcoming them benefit family,
friends, neighbors and community. Physicians,
married or unmarried, male or female, will find
themselves using this book to review and evaluate
their own ways of treating patients who are bored,
lonely, unable to love or to make love, the gen-
uinely overworked, the secretly fearful or guilty,
and the uncertain.

The Story of Dissection. By Jack Kevor-
kian, M.D., New York: Philosphical Li-
brary. 1959.

The author has neglected no period from ear-
liest history to the beginning of the twentieth
century in his anatomic considerations. In a very
small volume a wealth of information has been
presented, which makes not only engrossing read-
ing, but serves as a valuable addition to reference
material.

A sincere attempt has been made to explain the
progress, or lack of progress, not only in dissec-
tion and the anatomical knowledge derived, but in
medical science in general, in the light of existing
conditions and opinions of each successive era. It
is only to be regretted that more lengthy discus-
sions could not have been included in this survey.
Finally, the author is to be congratulated on the
excellence of his composition and style.

The Teen-Age Years: A Medical Guide for
Young People and Their Parents. By
Arthur Roth, M.D. 288 pages. Price, $3.75.
New York: Doubleday & Company, 1960.

This book is the result of six years of exper-
ience on the part of the author as founder-director
of the Teen-age Clinic at the Kaiser Foundation
Medical Center in Oakland, California. It deals

specifically with medical problems of the adoles-
cent. Among the topics discussed are problems of
sexual maturing, skin care and grooming, ortho-
pedic problems, and the vague ailments — "aches"
and "tiredness" — common to young people. Dr.
Roth also explores the standards of normalcy in
adolescence and explodes what he calls "the false
cult of the average": the teen-ager's acute worry
that he is too tall, too short, too anything
that is not "normal."

Dr. Roth received his M.D. degree from Western
Reserve University and served his internship and
pediatric residence in California and at Boston
Children's Medical Center. The staff of his teen-
age clinic at Oakland now numbers nine, and the
case load has climbed from 25 to nearly 500
monthly.

Biological Stains — A Cross Index
A new technical reference booklet dealing with
the uses of Biological Stains has been published
by Allied Chemical's National Aniline Division.

The 12-page booklet cross-indexes an alphabetic-
al listing of the principal uses of Certified Biolog-
ical Stains and Biological Stains supplied by Na-
tional Aniline, grouped according to the field in
which the stains are used.

Since all biological stains certified by the Bio-
logical Stain Commission are obtainable from Na-
tional Aniline, this comprehensive cross-index
serves as a reference aid to the student of labor-
atory technology, the established laboratory tech-
nician and those engaged in general scientific re-
search.

Copies of the booklet. "Biological Stains — A
Cross Index," are available from Allied Chemical's
National Aniline Division, 40 Rector Street, New
York 6, New York.

Mead Johnson Announces New Hay Fever Drug

A new anti-allergic drug that protects the user
against a wide range of allergic symptoms and
itching for up to 12 hours on a single dose was
announced at the American Medical Association's
annual meeting recently.

The new agent is methdilazine hydrochloride. It
was developed by Mead Johnson & Company of
Evansville, Indiana, and is being marketed under
the tradename Tacaryl. It is being introduced na-
tionally simultaneously with the A.M. A. meeting
announcement.

Tacaryl is available at drug stores on a doctor's
prescription. It is being marketed as 8 mg. scored
tablets in bottles of 100, and as a fruit-flavored
syrup in 16 oz. bottles. Usual daily dosage is one
tablet or two teaspoonfuls of syrup twice daily
for adults, and one-half tablet or one teaspoonful
syrup twice daily for children.

312

NORTH CAROLINA MEDICAL JOURNAL

July. 1960

!

3n ilnnonam

William Wills Green, M.D.

William Wills Green was born on July 29, 1885,
in Franklin County, North Carolina and was edu-
cated in the schools of that community, Horner's
Military Academy, and the University of North
Carolina, being graduated in 1908. He began the
practice of medicine and surgery in Tarboro in
1910 and remained active until one month before
his death on March 12, 1960 The only interruption
in his practice was for service in the Army Med-
ical Corps in World War I with the rank of Major.
He was an active member of the County, District,
and State Medical Societies and the American
Medical Associaion for 50 years, and was a past
president of the Edgecombe-Nash Medical Society.
He was a member of the American College of Sur-
geons. He was an active member of the Howard
Memorial Presbyterian Church of Tarboro and the
Tarboro Rotary Club.

The death of Dr. Green has removed from us
one of our most beloved and outstanding citizens.
He loved people and in turn was loved by them.
One had only to view the great mass of flowers
and the crowd at his final rites to know that here
indeed was a friend of man.

Dr. Green contributed of his time and talents in
many ways for the betterment of Tarboro and
Edgecombe Couny. Not only did he give of his
outstanding professional skill to all, without re-
gard to color or creed, social or financial standing,
but he was always ready to help with anything
that represented improvement and advancement for
his fellow man. For 25 years he was chairman of
the Edgecombe County Board of Education and un-
doubtedly to him goes a large share of the credit
for our splendid school system He worked tire-
lessly to raise money for improvement of the phy-
sical equipment and lived to realize his dream of
seeing the one-room school house replaced by
modern schools.

Several years ago when it became apparent that
the existing local hospital facilities were inadequate.
Dr. Green again gave his time and ability in help-
ing plan a new hospital and worked hard and long
in promoting the passage of a bond issue neces-
sary for the construction of the new Edgecombe
General Hospital. For 26 years he was Chief of
Staff of the old hospital, a position he held in the
new one at the time of his death.

A small insight into the character of this truly
great man can be gotten from the fact that when
the Tarboro Little League was formed. Dr. Green
assumed the position of co-chairman of the finance
committee, and each year personally went to bus-
iness firms and individuals and solicited much of
the money. Therefore

Be it resolved: That the Edgecombe-Nash Med-
ical Society has lost a valuable member and each
of us a true friend; and that we, the members of
the Edgecombe-Nash Medical Society express our
deep sorrow and extend sympathy to his family;
and that a copy of these resolutions be placed in
the permanent files of this Society, a copy be sent
to his family, and a copy be sent to the North
Carolina Medical Journal.

W. K. McDowell, M.D.

A. C. Norfleet, M.D.

The Month am WasMaigtom

(CONTINUED FROM PAGE 309)

Prior to approving the Mills plan, the
committee rejected the Forand bill (three
times) and the Eisenhower Administra-
tion's far-reaching public assistance altern-
ative. Both plans were opposed by the med-
ical profession and allied groups.

While these legislative proposals were in
the limelight, a little-noticed bill was en-
acted into law to give $50 million in relief
to taxpayers burdened with taking care of
ill dependent parents.

The new law permits taxpayers full de-
duction on federal income taxes for medical
and dental expenses paid for a dependent
parent 65 years of age and older. Previous-
ly, such a deduction was limited to costs in
excess of three per cent of the taxpayer's
adjusted gross income.

Changes in the Social Security program
called for in the catch-all bill approved by
the Ways and Means Committee would :

1. Eliminate the requirement that a dis-
abled person must be at least 50 years old
to be eligible for Social Security benefits.

2. Provide Social Security benefits for
about 25,000 widows of workers who died
before 1940.

3. Increase the benefits of 400,000 surviv-
ing children of workers covered by Social
Security.

Although all these revisions will increase
costs of the program, neither the Social
Security tax rate nor tax base was in-
creased.

The revisions will mark the fifth conse-
cutive year of a national election that the
Social Security program, originally enacted
in 1935, has been expanded. Some of the
expansions have been accompanied by tax
increases.

when you see
signs of
anxiety-tension

specify

dihydrochloride

brand of thiopropazate dihydrochloride

for rapid relief of anxiety manifestations

■" 2? * */* *

You will find Dartal outstandingly beneficial
in management of the anxiety -tension states
so frequent in hypertensive or menopausal
patients. And Dartal is particularly useful
in the treatment of anxiety associated with
cardiovascular or gastrointestinal disease, or
the tension experienced by the obese patient
on restricted diet. You can expect consistent
results with Dartal in general office practice.

with low dosage: Only one 2, 5 or 10 mg. tablet
t.i.d. with relative safety: Evidence indicates Dartal
is not icterogenic.

Clinical reports on Dartal: 1. Edisen, C. B., and Samuels,
A. S.: A.M.A. Arch. Neurol. & Psychiat. 80:481 (Oct.) 1958.

2. Ferrand, P. T.: Minnesota Med. 41:853 (Dec.) 1958.

3. Mathews, F. P.: Am. J. Psychiat. 114:1034 (May) 1958.

SEARLE

v :

XXXVI

NORTH CAROLINA MEDICAL JOURNAL

July, 1900

m

whenever there is inflammation,
swelling, pain

VARIDASE

6TREirrOKINASE-STREPTOOOBNA3E LEOEOLE

BUCCAL™^

conditions for a
fast comeback . . .

5 days of classic therapy after 48 hours of VARIDASE

as in cellulitis*

Until Varidase stemmed infection,
inflammation, swelling and pain, neithe-
medication nor incision and drainage
had affected the increasing cellulitis.

Varidase mobilizes the natural healing
process, by accelerating fibrinolysis, to
condition the patient for successful primary
therapy. Increases the penetrability of the
fibrin wall, for easy access by antibodies
and drugs . . . without destroying limiting
membrane . . . and limits infiltration.
Prescribe Varidase Buccal Tablets routinely
in infection or injury.

*lnnerfield. I.: Clinical report cited with permission.

Varidase Buccal Tablets contain:

10.OIIO Units Streptokinase, 2.">00 Units Streptodornase.

Supplied: Boxes of 24 and 100 tablets

LEDERLE LABORATORIES,

A Division of American Cyanamid Company, Pearl River, N. Y.

July, 1960

ADVERTISEMENTS

XXXVII

AN AMES CLINIQUICr

CLINICAL BRIEFS FOR MODERN PRACTICE

'-•

WHAT

LABORATORY

PROCEDURES

ARE INDICATED IN

DIABETICS WITH

URINARY TRACT

INFECTIONS?

A urine culture is absolutely essential in the diabetic suspected of having a urinary tract infec-
tion since such infection is not always accompanied by pyuria. It is also essential to keep the
urine free from sugar— as shown by frequent urine-sugar tests— for successful therapy.

Source: Harrison, T. R., el at.: Principles of Internal Medicine, ed. 3, New York, McGraw-Hill Book Co., 1958, p. 620.

the most effective method of routine testing for glycosuria,
color-calibrated

L i ITEST

«"""> Reagent Tablets

the standardized urine-sugar test for reliable quantitative estimations

Urinary tract infections are about four times more frequent in the diabetic than in
the non-diabetic. The prevention and treatment of urinary tract infections, as well as
the avoidance of other complications of diabetes, are significantly more effective in the
well-controlled diabetic. The patient should be impressed repeatedly with the importance
of continued daily urine-sugar testing— especially during intercurrent illness— and warned
of the consequences of relaxed vigilance.

"lirine-SUgar profile" With the new Graphic Analysis Record included in the Clinitest

Urine-Sugar Analysis Set (and in the tablet refills), daily urine-sugar readings may be recorded to
form a graphic portrayal of glucose excretion most useful in clinical control. ^^^^^eaaeo

• motivates patient cooperation through everyday use of Analysis Record

• reveals at a glance day-to-day trends and degree of control

• provides a standardized color scale with a complete range in the familiar blue-to
orange spectrum

guard against ketoacidosis

...test for ketonuria

for patient and physician use

ADDED SAFETY FOR DIABETIC CHILDREN

ACETESF KET0STIX@

Reagent Tablets Reagent Stripy

AMES

COMPANY. INC

Elkhart • Indiana
Toronto • Canada

f A?

XXXVIII

NORTH CAROLINA MEDICAL JOURNAL

July, 1960

The choice of confidence...

diagnostic x-ray equipment
planned for private practice!

Few who purchase x-ray equipment have
time to thoroughly test the quality of mate-
rials, workmanship and technical perform-
ance offered by all the makes of x-ray units.
And happily this is not necessary.

The manufacturer's reputation is worth
more than anything else to you in choosing
x-ray equipment, one of the most complex
professional investments you will ever face.

General Electric has created "just what
the doctor ordered" in the 200-ma Patrician,
in terms of both reasonable cost and operat-
ing qualities. Here diagnostic x-ray is ideally

tailored to private practice. Patrician pro-
vides everything you need for radiography
and fluoroscopy — and with consistent end
results, since precise radiographic calibration
is as much a part of the Patrician combina-
tion as it is of our most elaborate installa-
tions. For complete details contact your G-E
x-ray representative listed below.

Thgress Is Our Most Important Product

general!! electric

Direct Factory Branch
CHARLOTTE

1140 Elizabeth Ave.
FR 6-1531

NORTH CAROLINA

Resident Representatives
WILSON

A. L. Harvey

1501 Branch St. • Phone 23 7-2440

WINSTON-SALEM

N. E. Bolick
1218 Miller St. • Phone PArk 4-5864

July, 1960

ADVERTISEMENTS

XXXIX

Ar

the i(|
site 1

of

— ., : ,

Following determination
of basal secretion,
intragastric pH was
continuously determined
by means of frequent
readings over a
two-hour period.

peptic
ulcer

PH Data based on pH measurements in 11 patients with peptic ulcer1

1.5

Neutralization
with standard
aluminum hydroxide

neutralization
is much
faster and
twice
as long
with

60

Ma" CREAMALIN AN1BC,°

LABORATORIES !
New York 18, N. Y,

TABLETS

New proof in vivo" of the much greater efficacy of new Creamalin
tablets over standard aluminum hydroxide has now been ob-
tained. Results of comparative tests on patients with peptic ulcer,
measured by an intragastric pH electrode, show that newCreamalin
neutralizes acid from 40 to 65 per cent faster than the standard
preparation. This neutralization (pH 3.5 or above) is maintained
for approximately one hour longer.

New Creamalin provides virtually the same effects as a liquid
antacid2 with the convenience of a tablet.
Nonconstipating and pleasant-tasting, new Creamalin antacid
tablets will not produce "acid rebound" or alkalosis.
Each new Creamalin antacid tablet contains 320 mg. of specially
processed, highly reactive, short polymer dried aluminum hy-
droxide gel (stabilized with hexitol) with 75 mg. of magnesium
hydroxide. Minute particles of the powder offer a vastly increased
surface area for quicker and more complete acid neutralization.

Dosage: Gastric hyperacidity -from 2 to 4 tablets as necessary. Peptic
ulcer or gastritis - from 2 to 4 tablets every two to four hours. Tablets may
be chewed swallowed whole with water or milk, or allowed to dissolve
in the mouth. How supplied: Bottles of 50, 100, 200 and 1000.
1. Data in the files of the Department of Medical Research, Winthrop
Laboratories. 2. Hinkel, E. T., Jr.; Fisher, M. P., and Tainter, M. L.: J. Am.
Pharm. A. (Sclent. Ed.) 48:384, July, 1959.

for peptic ulcer Hgastritis ■gastric hyperacidity

XL

NORTH CAROLINA MEDICAL JOURNAL

July. l''-0

Diagnostic

Quandaries

Colitis? Gall Bladder Disease?

Chronic Appendicitis ?

Rheumatoid A rthritis ? Regional Enteritis ?

W Wi DISEASE that is frequently
■ A V overlooked in solving diag-
"fll ' nostic quandaries is amebiasis.
■■Hi1 Its symptoms are varied and
contradictory, and diagnosis is extremely
difficult. In one study, 56% of the cases
would have been overlooked if the routine
three stool specimens had been relied on.1

Another study found 96% of a group
of 150 patients with rheumatoid arthritis
were infected by E. histolytica. In 15 of
these subjects, nine stool specimens were
required to establish the diagnosis.2

Webster discovered amebic infection in
147 cases with prior diagnoses of spastic
colon, psychoneurosis, gall bladder dis-
ease, nervous indigestion, chronic appen-
dicitis, and other diseases. Duration of
symptoms varied from one week to over
30 years. In some cases, it took as many
as six stool specimens to establish the
diagnosis of amebiasis.3

Now treatment with Glarubin provides
a means of differential diagnosis in sus-
pected cases of amebiasis. Glarubin, a
crystalline glycoside obtained from the
fruit of Simarouba glauca, is a safe, effec-
tive amebicide. It contains no arsenic,
bismuth, or iodine. Its virtual freedom
from toxicity makes it practical to treat

suspected cases without undertaking dif-
ficult, and frequently undependable, stool
analyses. Marked improvement following
administration of Glarubin indicates path-
ologically significant amebic infection.

Glarubin is administered orally in tablet
form and does not require strict medical
supervision or hospitalization. Extensive
clinical trials prove it highly effective in
intestinal amebiasis.

Glarubin*

TABLETS

specific for intestinal amebiasis

Supplied in bottles of 40 tablets, each
tablet containing 50 mg. of glaucarubin.

Write for descriptive literature, bibli-
ography, and dosage schedules.

!. Cook, JE., P-riccs, C. \V , and Hlndley. F.W.: Chronic Ame-
bfasis and Ihe Need Tor a Diagnostic Prolile. Am. Pract and Die
ol Treat. ff:1821 (Dec , 1955).

2. Rlnehart, K. E„ and Marcus, H : Incidence of Amebiasis in
Healthy Individuals, clinic Patients and Tliose with Rheumatoid
Arthritis. Northwest Med.. o^:70S (July, 1955).

3. Webster. B.H.: Amebiasis, a Disease of Multiple Manifesta-
tions. Am. Pract. and Dig. of Treat. S:S97 (June. 195S).

•U.S. Pat. N8. 2.S64.745

THE S.E. |y|ASSENGILL COMPANY

NEW YORK

BRISTOL, TENNESSEE
KANSAS CITY

SAN FRANCISCO

July, 1960

ADVERTISEMENTS

IN CONTRACEPTION...

XLI
~1

WHY IS SPEEDIER SPERMICIDAL ACTION IMPORTANT?

Because a swift-acting spermicide best meets the variables of spermatozoan activity.

Lanesta Gel, ". . . found to immobilize human sper-
matozoa in one-third to one-eighth the time required
by five of the leading contraceptive products currently
available . . ."* thus provides the extra margin of
assurance in conception control. The accelerated
action of Lanesta Gel — it kills sperm in minutes in-
stead of hours — may well mean the difference
between success and failure.

•Berberian, D. A., and Slighter, R. G.: JAMA. 168:2257
(Dec. 27) 1958.

In Lanesta Gel 7 -chloro-4-indanol, a new, effective,
nonirritating, nonallergenic spermicide produces im-
mediate immobilization of spermatozoa in dilution
of up to 1:4,000. Spermicidal action is greatly accel-

erated by the addition of 10% NaCl in ionic form.
Ricinoleic acid facilitates the rapid inactivation and
immobilization of spermatozoa and sodium lauryl
sulfate acts as a dispersing agent and spermicidal
detergent.

Lanesta Gel with a diaphragm provides one of the
most effective means of conception control.
However, whether used with or without a
diaphragm, the patient and you, doctor, can
be certain that Lanesta Gel provides .faster
spermicidal action — plus essential diffusion
and retention of the spermicidal agents in
a position where they can act upon the
spermatozoa.

t-ii

■ . .

Lanesta Gel

Supplied: Lanesta Exquiset . . . with diaphragm of prescribed size and type; universal introducer; \ f^ DfOdllCt

Lanesta Gel, 3 oz. tube, with easy clean applicator, in an attractive purse. Lanesta Gel, 3 oz. tube with ] x I antefin®

applicator; 3 oz. refill tube — available at all pharmacies. ; ,

Manufactured by Esta Medical Laboratories, Inc., Alliance, Ohio Distributed by George A, Breon & Co., New York 18, N Y. <,... " : .

XLII

NORTH CAROLINA MEDICAL JOURNAL

July, l'.-'O

I

J

no irritating crystals • uniform concentration in each drop"
STERILE OPHTHALMIC SOLUTION

NEO HYDELTRASOL

2,000 TIMES MORE SOLUBLE THAN

"The solution of prednisolone has the

advantage over the suspension in that no

crystalline residue is left in the patient's

cul-de-sac or in his lashes .... The other

advantage is that the patient does not have to

shake the drops and is therefore sure of

receiving a consistent dosage in each drop."2

PREDNISOLONE 2\- PHOSPHATE-NEOMYCIN SULFATE

PREDNISOLONE OR HYDROCORTISONE

1. Lippmann. 0.: Arch Ophth. 57:339. March 1957.

2. Gordon, D.M.: Am. J. Ophth. 46:740. November 1958.
supplied: 0.5% Sterile Ophthalmic Solution NEO-
HYDELTRASOL (with neomycin sulfate) and 0.5% Sterile
Ophthalmic Solution HYDELTRASOL'. In 5 cc. and 2.5 cc
dropper vials Also available as 0.25% Ophthalmic
Ointment NEO-HYDELTRASOL (with neomycin sulfate)
and 0.25% Ophthalmic Ointment HYDELTRASOL.
In 3.5 Gm. tubes

HYDELTRASOL and NEO-HYDELTRASOL are trademarks of Merck S Co.. Inc.
^m MERCK SHARP & DOHME Division of Merck & Co, Inc.. Philadelphia 1. Pa.

XLIII

ORIGINAL FORMULA

The ideal cerebral tonic and stimulant for the aged.

NICOZOL therapy (the original formula) affords
prompt relief of apathy. Patients generally look
better, feel better; become more cooperative,
cheerful and easier to manage.
No dangerous side effects.

NICOZOL contains pentylenetetrazol
and nicotinic acid

For relief of agitation and hostility:
NICOZOL with reserpine Tablets

Supply: Capsules • Elixir

Write for professional sample and literature.

see
Page 666

DRUG

C^jj^ff^f^ WINSTON-SALEM 1, NORTH CAROLINA

XLIV

NORTH CAROLINA MEDICAL JOURNAL

July, 1960

l'AGrs. Ea.
FLAVORED

I

Living up to
a family tradition

There are probably certain medications which are
special favorites of yours, medications in which
you have a particular confidence.

Physicians, through ever increasing recommen-
dation, have long demonstrated their confidence
in the uniformity, potency and purity of Bayer
Aspirin, the world's first aspirin.

And like Bayer Aspirin, Bayer Aspirin for Chil-
dren is quality controlled. No other maker submits
aspirin to such thorough quality controls as does
Bayer. This assures uniform excellence in both
forms of Bayer Aspirin.

You can depend on Bayer Aspirin for Children
for it has been conscientiously formulated to be
the best tasting aspirin ever made and to live up
to the Bayer family tradition of providing the finest
aspirin the world has ever known.

Bayer Aspirin for Children- IVi grain flavored
tablets-Supplied in bottles of 50.

• We welcome your requests for samples on Bayer
Aspirin and Flavored Bayer Aspirin for Children.

GRIP-TIGHT CAP
for Children's
Greater Protection

""•mix "wi m*V*

W BAYER

11 ASPIRIN \

^CHILDREN

THE BAYER COMPANY. DIVISION OF STERLING QRUG INC.. 1450 BROADWAY. NEW YORK 18. N. Y.

July, 1960

ADVERTISEMENTS

XLV

in arthritis and allied
disorders

Butazolidin"

brand of phenylbutazone

Geigy

Since its anti-inflammatory properties
were first noted in Geigy laboratories 10
years ago, time and experience have
steadily fortified the position of
Butazolidin as a leading nonhormonal
anti-arthritic agent. Indicated in. both
chronic and acute forms of arthritis,
Butazolidin is noted for its striking
effectiveness in relieving pain,
increasing mobility and halting
inflammatory change.

Proved by a Decade of Experience
Confirmed by 1700 Published Reports
Attested by World-Wide Usage

Butazolidin®, brand of phenylbutazone:
Red, sugar-coated tablets of 100 mg.
Butazolidin® Alka: Orange and white
capsules containing Butazolidin 100 mg.;
dried aluminum hydroxide gel 100 mg.;
magnesium trisilicate 150 mg.;
homatropine methylbromide 1.25 mg,

Geigy, Ardsley, New York wjgf

-• ' 'ffllBPBK'flnPtiiFr*i ^t..

1 wA ""*"- -^ :/*m^m

^\ \j

162-60

XLVI

NORTH CAROLINA MEDICAL JOURNAL

July, I960

\

.

for treatment of

Peptic Ulcers
and Hyperacidity

Brand of Hyamagnate

...

Neutralizes excess acidity
Sustains acid-base balance

Glycamine Is a New Chemical Compound

— not a mixture of alkalis — that re-establishes nor-
mal digestion without affecting enzymatic activity.
Glycamine's CONTROLLED ACTION does not
stimulate acid secretion or alkalosis.

NON-SYSTEMIC Glycamine is compatible with
antispasmodics and anticholinergics.

Pn&tiytibe

GLYi \>II.\E TABLETS \>M I.IIM III

Available in bottles of lOO. 500
and lOOO tablets; or pints.

Loic dosage
prorides prompt
long lasting relief

• Only four pleasant

tasting, chew-up

tablets or four

teaspoonfuls needed

dally. Each dosage

maintains optimum

pH for 4'A hours.

PHARMACEUTICALS

May ran 1 1

me.

Greensboro, North Carolina

July, 1960

ADVERTISEMENTS

XLVII

HELP US KEEP THE
THINGS WORTH KEEPING

It's good to be a boy, exploring the
wide world, soaking up wonderful
new sounds and sights everywhere
you go. And if the world's a peaceful
place, it's good to grow up, too, and
become a man.

But will the world stay peaceful?
That depends on whether we can keep
the peace. Peace costs money.

Money for military strength and

for science. And money saved by
individuals to help keep our economy
strong.

Your Savings Bonds make you a
Partner in strengthening America's
Peace Power.

The Bonds you buy will earn good
interest for you. But the most im-
portant thing they earn is peace.
Are you buying enough?

HELP STRENGTHEN AMERICA'S PEACE POWER

BUY U. S. SAVINGS BONDS

The U.S. Government does not pay for this advertising. The Treasury Department thanks
The Advertising Council and this magazine for their patriotic donation.

VW

4 1-2x6 1-2 in. 100 Screen SBD-GM-59-12

XLVIII

NORTH CAROLINA MEDICAL JOURNAL

July, 1960

A Vacation from Hay Fever
is a Real Vacation

ANYWHERE - ANYTIME

Just a "poof" of fine nTz spray

brings relief in seconds, for hours

NlZ is a potentiated, balanced
combination of these well known
synergistic compounds :
Neo-Synephrine® HC1, 0.5%

- dependable vasoconstrictor
and decongestant.

Thenfadil® HC1, 0.1%

- potent topical
antihistaminic.

Zephiran® CI, 1:5000

- antibacterial wetting
agent and preservative.

NASAL SPRAY

Supplied in leakproof,-^^s

pocket size o^x

squeeze bottles of 20 cc. "^ ^

UUn/tOp IABORATOHIES >vj

I Newrotk it.y I. JtM

July, 1960

ADVERTISEMENTS

XLIX

NORTH CAROLINA MEDICAL JOURNAL

July. 19fi0

More mileage...

The older man in industry needs the
help of doctor, management, and home-
maker ... to extend his years of pro-
ductivity.

A recent study of presumably healthy
men in business showed nearly one-
third to be obese. Many suffered from
diseases of nutritional origin or requir-
ing special dietary treatment.

Obesity is associated with increased
incidence of many serious diseases . . .
chronic illnesses occurring with about
twice the frequency among obese indi-
viduals 40 to 59 years of age as among
those of normal weight. At all ages,
more deaths occur among the obese.
Evidence indicates obesity is becoming
more frequent among men . . . increas-
ing the health hazard during middle
years.

Mechanization of industry increases
the value of the skilled and experienced
worker. . .while decreasing his physical
activity and energy needs . . . and in-

creasing his need for choosing foods of
high nutrient content in relation to cal-
orie value. Milk is such a food.

Three glasses of milk a day ... to
drink . . used in food preparation . . .
as cheese or ice cream . . . will provide
all the calcium needs of men . . . and
supply generous amounts of high qual-
ity protein and other essential nutrients.

In planning meals to maintain and
extend productivity of the man in
industry, milk and milk products are
foundation foods for good eating and
good health.

The nutritional statements made by this
advertisement have been revielted by the
Council on Fo^ds and Nutrition of the Ameri-
can Medical Association and jound consistent
with current authoritative medical opinion.

S:nce 1915 . . . promoting better health
through nutrition, research and education.

NATIONAL DAIRY COUNCIL

A non-profit organization
111 N. Canal Street • Chicago 6, 111.

THIS ADVERTISEMENT IS ONE OF A SERIES. REPRINTS ARE AVAILABLE UPON REQUEST

This information is reproduced in the interest of good nutrition and health by the Dairy

Council Units in North Carolina.

Burlington-Durham-Raleigh

310 Health Center Bldg.
Durham. N. C.

High Point-Greensboro
106 E. Northwood St.
Greensboro, N. C.

Winston-Salem
610 Coliseum Drive
Winston-Salem, N. C.

July, 1960

ADVERTISEMENTS

LI

51to49...it'saboy!

94 to 6 BONADOXIN'stops morning sickness

When she asks "Doctor, what will it
be?" you can either flip a coin or point
out that 51.25% births are male.1 But
when she mentions morning sickness,
your course is clear: bonadoxin.

For, in a series of 766 cases of morning
sickness, seven investigators report ex-
cellent to good results in 94 %.2 More
than 60 million of these tiny tablets
have been taken. The formula: 25 mg.
Meclizine HC1 (for antinauseant ac-
tion) and 50 mg. Pyridoxine HC1 (for

metabolic replacement). Just one tablet
the night before is usually enough.

bonadoxin — drops and Tablets— are
also effective in infant colic, motion
sickness, labyrinthitis, Meniere's syn-
drome and for relieving the nausea and
vomiting associated with anesthesia and
radiation sickness. See pdr p. 795.

1. Projection from Vital Statistics, U.S. Govern-
ment Dept. HEW, Vol. 48, No. 14, 1958, p. 398.

2. Modell. W. : Drugs of Choice 1958-1959, St. Louis,
C. V. Mosby Company, 1958, p. 347,

New York 17, New York
Division. Chas. Pfizer & Co., Inc.
Science for the World's Well-Being

LII

NORTH CAROLINA MEDICAL JOURNAL

July, 1960

"TMh

whenever depression
complicates the picture

In many seemingly mild physical disorders
an element of depression plays an
insidious etiologic or complicating role.

Because of its efficacy as an antidepres-
sant, coupled with its simplicity of usage,
Tofranil is admirably adapted to use in the
home or office in these milder "depression-
complicated" cases.

Tofranil

brand of imipramine HCI

hastens recovery

Geigy

It is always wise to recognize that depres-
sion may be an underlying factor... that
Tofranil may speed recovery in "hypochon-
driasis"; in convalescence when recovery
is inexplicably prolonged; in chronic illness
with dejection; in the menopausal patient
whose emotional disturbances resist
hormone therapy; and in many other com-
parable situations in which latent depres-
sion may play a part.

Detailed Literature Available on Request.

Tofranil*, brand of imipramine hydrochloride,
tablets of 25 mg. Ampuls for intramuscular
administration, 25 mg. in 2 cc. of solution.

160-60

Geigy, Ardsley, New York

July, 1960 ADVERTISEMENTS LIH

I Major Hospital Policy

Pays up to $10,000.00 for each member of your family,
subject to deductible you choose

Deductible Plans available:
$100.00
$300.00
I $500.00

1

:

Business Expense Policy

Covers your office overhead while you
are disabled, up to $1,000.00 per month

Write or Call
for information

Ralph ]. Golden Insurance Agency

Phones: BRoadway 5-3400 BRoadway 5-5035

I
i.

i j l I

approved by I

I
The Medical Society of North Carolina

for Its Members

|

I

ivaipn ). ooiueii insurance regency

f Ralph J. Golden Associates Henry Maclin, IV |

I Harry L. Smith John Carson

I

108 East Northwood Street

Across Street from Cone Hospital

GREENSBORO, N. C.

1

MM

LIV

NORTH CAROLINA MEDICAL JOURNAL

July, 1960

whenever digitalis
is indicated

LANOXIN DIGOXIN

formerly known as Digoxin 'B. W. & Co.

v tnlis assent were
"If one digital ag

Ko recommended jor us

, Levine.S- A' 2J, par. Z-
Boston. U"«-

'LANOXIN' TABLETS
0.25 mg. scored (white)
0.5 mg. scored (green)

■M

'LANOXIN' INJECTION
0.5 mg. in 2 cc. (I.M. or I.V.)

'LANOXIN' ELIXIR PEDIATRIC

0.05 mg. in 1 cc.

URROUGHS WELLCOME & CO. (U.S.A.) INC., Tuckahoe, N.Y.

July, 1960

ADVERTISEMENTS

LV

How to be
Carefree
Without
Hardly
Trying • • •

It really takes a load off your mind. . .
to know that you are protected from
loss of income due to illness or accident!

"Dr. Carefree" has no 30-day
sick leave ... no Workmen's
Compensation . . . BUT he has a
modern emergency INCOME PROTEC-
TION PLAN with Mutual of Omaha.

When he is totally disabled by accident or sickness covered by this plan, this plan
will give him emergency income, free of Federal income tax, eliminating the night-
mare caused by a long disability.

Thousands of members of the Medical Profession are protected with Mutual of Oma-
ha's PROFESSIONAL MEN'S PLAN, especially designed to meet the needs of the
profession.

If you do not already own a Mutual of Omaha INCOME PROTECTION PLAN, get in
touch now with the nearest General Agent, listed below. You'll get full details, with-
out obligation.

m

OF OMAHj

Largest Exclusive Health and Accident Company in the World.

G. A. RICHARDSON, General Agent
Winston-Salem, N. C.

J. A. MORAN, General Agent
Wilmington, N. C.

J. P. GILES, General Agent
Asheville, N. C.

LVI

NORTH CAROLINA MEDICAL JOURNAL

July, 1960

TUCKER HOSPITAL, Inc.

212 West Franklin Street
Richmond, Virginia

A private hospital for diagnosis and treatment of psychiatric and neurol-
ogical patients.
Hospital and out-patient services.

(Organic diseases of the nervous system, psychoneuroses, psychosomatic
disorders, mood disturbances, social adjustment problems, involutional
reactions and selective psychotic and alcoholic problems.)

Dk. James Asa Shield

Dr. Weir M. Tucker

Dr. George S. Fultz

Dr. Amelia G. Wood

Protection Against Loss of Income
from Accident & Sickness as Well as
Hospital Expense Benefits for You and
All Your Eligible Dependents

All

PREMIU MS

COME FRO**

PHYSICIANS
SURGEONS
DENTISTS

All

BENE FITS

60 TO

PHYSICIANS CASUALTY & HEALTH
ASSOCIATIONS

OMAHA 31, NEBRASKA
Since 1902

Jandsome Professional Appointment Book sent to
you FREE upon request.

Compliments of

WachtePs, Inc*

SURGICAL
SUPPLIES

65 Haywood Street

ASHEVILLE, North Carolina
P. O. Box 1716 Telephone 3-7616—3-7617

July, 1960

ADVERTISEMENTS

LVII

..*^,f*?bs* •

V Convalescence

1-'

fant diarrhea

Old age

Whenever
the diet is faulty,
the appetite poor,
or the loss of food
is excessive

through vomiting
or diarrhea —

Valentine's

MEAT EXTRACT

stimulates the appetite,

increases the flow of
digestive juices,

provides: supplementary
amounts of vitamins, minerals
and soluble proteins,

extra-dietary vitamin Bu,

protective quantities of
% potassium, in a palatable and
; 4, readily assimilated form.

.Postoperatively

Debilitating
gastrointestinal

conditions

Supplied in bottles of 2 or 6 fluidouncti.

Dosage is 1 teaspoonful two or three times
daily; two or three times this amount for
Potassium therapy.

VALENTINE Company, Inc.

RICHMOND 21, VIRGINIA

Of special x~Cjf

significance

to the -—V

physician /~r

is the symbol I' ':•,

When he sees it engraved
on a Tablet of Quinidine Sulfate

he has the assurance that

the Quinidine Sulfate is produced

from Cinchona Bark, is alkaloidally

standardized, and therefore of

unvarying activity and quality. .

When the physician writes "DR"
(Davies, Rose) on his prescriptions
for Tablets Quinidine Sulfate, he is

assured that this "quality" tablet
is dispensed to his patient.

Rx Tablets Quinidine Sulfate Natural

0.2 Gram (or 3 grains)

Davies, Rose

Clinical samples sent to physicians on request

Davies, Rose St Company, Limited
Boston 18, Mass. ..

LVIII

NORTH CAROLINA MEDICAL JOURNAL

July. 1960

O-way support

for the

aging patient...

ASSISTS PROTEIN UPTAKE
IMPROVES MENTAL OUTLOOK
AIDS NUTRITIONAL INTAKE

N

®

Geriatric Vitamins-Minerals-Hormones-d-Amphetamine lederle

Each capsule contains: Ethinyl Estradiol 0.01 mg. • Methyl
Testosterone 2.5 mg. • d-Amphetamine Sulfate 2.5 mg. • Vitamin
A (Acetate) 5,000 U.S. P. Units • Vitamin D 500 U.S. P. Units •
Vitamin B„ with AUTRINIC"' Intrinsic Factor Concentrate 1/15
U.S.P. Unit (Oral) • Thiamine Mononitrate (B.l 5 mg. • Ribo-
flavin (B2) 5 mg. • Niacinamide 15 mg. • Pyridoxine HCI (B6)
0.5 mg. • Calcium Pantothenate 5 mg. • Folic Acid 0.4 mg. •
Choline Bitartrate 25 mg. • Inositol 25 mg. • Ascorbic Acid (C)

as Calcium Ascorbate 50 mg. • l-Lysine Monohydrochloride
25 mg. • Vitamin E (Tocopherol Acid Succinate) 10 Int. Units •
Rutin 12.5 mg. • Ferrous Fumarate (Elemental iron. 10 mg.)
30.4 mg. • Iodine (as Kl) 0.1 mg. • Calcium (as CaHP04) 35 mg.
• Phosphorus (as CaHP0d) 27 mg, ■ Fluorine (as CaFj) 0.1 mg. •
Copper (as CuO) 1 mg. • Potassium (as K,S04) 5 mg. • Manganese
(as MnO;l 1 mg. • Zinc (as ZnO) 0.5 mg. • Magnesium (MgO)
1 mg. • Boron (as NaAOj.lOHiO) 0.1 mg. Bottles of 100, 1000.

LEDERLE LABORATORIES, a Division of AMERICAN CYANAMID COMPANY, Pearl River, New York

Come to Mt. Pisgah and be tranquillized
by nature. Rustic inn & cottages perched
high on slope in National Forest near
Asheville. Heavenly quiet. Cool. Over-
looks glorious Great South View. Exhil-
arating air, superb food. Refuge and
restorative for tired doctors. May 1-Oct.
31.

Write

PISGAH FOREST INN

Candler, N. C. Rr. 1, Box 433

STOP

CLIMBING

STAIRS

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Heart Strain

and Fatigue

with a

Home Elevator

Inclin-ator travels up and down
stairways — Elevette fits snugly
into closet space. Ideal for in-
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push-button controls. Uses or-
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hundreds of nearby homes. Call
or write today for free survey.

ELEVATORS

Freight & Passenger Elevators

Greensboro, North Carolina

Charlotte t Raleigh

Roanoke • Augusta • Greenville

July. 1960

ADVERTISEMENTS

LIX

e

f

« o

1

\

For Prevention and Reversal of

Cardiac Arrest

The Birtcher Mobile Cardiac Monitoring and Re-
suscitation Center*

Cardiac Arrest is an ever present danger during
anesthesia

Cardiac arrest can occur during an anesthesia, even to
patients with no prior record of cardiac disease. Contin-
uous monitoring of every patient can prevent most
cardiac arrests by providing advance warning. For cases
where the accident cannot be prevented, instruments to
reverse the arrest and restore circulation should always
be instantly available.

*CompTised of the Birtcher Cardioscope, EEG Pre-Amplifier, Dual
Trace Electronic Switch, Electrocardiograph, Defibrillator and Heart-
pacer icith all necessary attachments on a Mobile Stand as shou-n.

Carolina Surgical Supply Company

"The House of Friendly and Dependable Service"

06 TUCKER ST. TEL: TEMPLE 3-8631

RALEIGH. NORTH CAROLINA

SAINT ALBANS

PSYCHIATRIC HOSPITAL

(A Non-Profit Organization)

Radford, Virginia

James P.
Daniel D. Chiles, M. D.

Clinical Director
James K. Morrow, M. D.
Silas R. Beatty, M. D.

STAFF

King, M. D., Director

William D. Keck, M. D.
Edward W. Gamble, III, M.
J. William Giesen, M. D.
Internist (Consultant)

Clinical Psychology:

Thomas C. Camp, Ph. D.
Artie L. Sturgeon, Ph. D.

Don Phillips
Administrator

AFFILIATED CLINICS

Bluefield Mental Health Center

525 Bland St., Bluefield, W. Va.

David M. Wayne, M. D.

Phone: DAvenport 5-9159

Charleston Mental Health Center

1119 Virginia St., E., Charleston, W. Va.

B. B. Young, M. D.

Phone: Dickens 6-7691

Beckley Mental Health Center

109 E. Main Street, Beckley, W. Va

W. E. Wilkinson, M. D.

Phone: CLifford 3-8397

Norton Mental Health Clinic

Norton Community Hospital, Norton
Pierce D. Nelson, M. D.
Phone: 218, Ext. 55 and 56

Va.

LX

NORTH CAROLINA MEDICAL JOURNAL

July. 1960

BRAWNER'S SANITARIUM, INC,

(Established 1910)
2932 South Atlanta Road, Smyrna, Georgia

FOR THE TREATMENT OF PSYCHIATRIC ILLNESSES
AND PROBLEMS OF ADDICTION

MODERN FACI LITI ES

Approved by Central Inspection Board of American Psychiatric Association
and the Joint Committee on Accreditation

Jas. N. Brawner, Jr., M.D.
Medical Director

Phone HEmlock 5-4486

HIGHLAND HOSPITAL, INC.

Founded In 1904

ASHEVILLE, NORTH CAROLINA

Affiliated with Duke University

A non-profit psychiatric institution, offering modern diagnostic and treatment procedures — insulin, electroshock, psy-
chotherapy, occupational and recreational therapy — for nervous and mental disorders.

The Hospital is located in a 75-acre park, amid the scenic beauties of the Smoky Mountain Range of Western North
Carolina, affording exceptional opportunity for physical and emotional rehabilitation.

The OUT-PATIENT CLINIC offers diagnostic service and therapeutic treatment for selected case desiring non-
resident care.

R. CHARMAN CARROLL, M.D.
Medical Director

ROBERT L. CRAIG, M.D.
Associate Medical Director

JOHN D. PATTON, M.D.
Clinical Director

July, 1960

ADVERTISEMENTS

LXI

ASHEVILLE

APPALACHIAN HALL

ESTABLISHED — 1916

NORTH CAROLINA

An Institution for the diagnosis and treatment of Psychiatric and Neurological illnesses, rest, convalescence, drug

and alcohol habituation.

Insulin Coma, Electroshock and Psychotherapy are employed. The Institution is eauipped with complete laboratory

facilities including electroencephalography and X-ray.

Appalachian Hall is located in Asheville, North Carolina, a resort town, wnich justly claims an all around climate

for health and comfort. There are ample facilities for classification of patients, rooms single or en suite.

Wm. Ray Griffin, Jr., M.D.
Robert A. Griffin, M.D.

For rates and further information write

Mark A. Griffin, Sr., M.D.
Mark A. Griffin, Jr., M.D.

APPALACHIAN HALL, ASHEVILLE, N. C.

When too many tasks

seem to crowd

the unyielding hours,

a welcome

"pause that refreshes"

with ice-cold Coca-Cola

often puts things

into manageable order.

LXII

NORTH CAROLINA MEDICAL JOURNAL

July, 19(50

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PHYSICIANS,

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Auxiliary or mail it to the Chicago office.

TODAY'S HEALTH

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Geriatric Vitamins-Minerals-Hormones-d-Amphetamine Lederle

Each capsule contains: Ethinyl Estradiol 0.01 mg. • Methyl
Testosterone 2.5 mg. • d-Amphetamine Sulfate 2.5 mg. • Vitamin
A (Acetate) 5,000 U.S. P. Units • Vitamin D 500 U.S.P. Units •
Vitamin B,2 with AUTRINIC ? Intrinsic Factor Concentrate 1 15
U.S.P. Unit (Oral) • Thiamine Mononitrate (B,) 5 mg. • Ribo-
flavin (B2) 5 mg. • Niacinamide 15 mg. • Pyridoxine HCI (B6)
0.5 mg. • Calcium Pantothenate 5 mg. • Folic Acid 0.4 mg. •
Choline Bitartrate 25 mg. • Inositol 25 mg. • Ascorbic Acid (C)

as Calcium Ascorbate 50 mg. • l-Lysine Monohydrochloride
25 mg. • Vitamin E (Tocopherol Acid Succinate) 10 Int. Units •
Rutin 12.5 mg. • Ferrous Fumarate (Elemental iron, 10 mg.)
30.4 mg. • Iodine (as Kl) 0.1 mg. • Calcium (as CaHPOJ 35 mg.
• Phosphorus (as CaHPO.,) 27 mg. • Fluorine (as CaF,) 0.1 mg. •
Copper (as CuOi 1 mg. • Potassium (as K;S04) 5 mg. • Manganese
(as MnO;) 1 mg, • Zinc (as ZnO) 0.5 mg. ■ Magnesium (MgO)
1 mg. • Boron (as Na2B.,0,.10H;0i 0.1 mg. Bottles of 100, 1000.

LEDERLE LABORATORIES, a Division of AMERICAN CYANAMID COMPANY, Pearl River, New York

July, 1960

ADVERTISEMENTS

LXIII

INDEX TO ADVERTISERS

American Casualty Insurance Company LIII

Ames Company ..XXXVII

Appalachian Hall LXI

Arnar-Stone Laboratories XXIII

Ayerst Laboratories XXVII

Brawner's Sanitarium LX

Brayten Pharmaceutical Company IX

George A. Breon XLI

Bristol Laboratories XII, XIII, XVIII, XXIV,

XXV, XXVIII
Burroughs-Welleome & Company XXII, LIV

Carolina Surgical Supply Co LIX

Coca Cola Bottling Company LXI

Columbus Pharmacal Company XLIX

J. L. Crumpton XXXIV

Dairy Council of North Carolina L

Davies, Rose & Co LVII

Drug Specialties, Inc. XLIII

Endo Laboratories XX

Geigy Pharmaceutical XLV, LII

General Electric X-Ray Dept XXXVIII

Glenbrook Laboratories (Bayer Co.) XLIV

Highland Hospital LX

Hospital Saving Assn. of N. C XXXI

Jones and Vaughan, Inc Ill

Lederle Laboratories XXI, XXVI, XXXII,

XXXIII, XXXVI, LVIII, LXII
Eli Lilly & Company XXX, Front Cover

The S. E. Massengill Company XL

May rand, Inc XLVI

Merck, Sharp & Dohme ... Second Cover, XLII

Monarch Elevator and Machine Co LVIII

Mutual of Omaha LV

Parke, Davis & Co LXIV, Third Cover

Physicians Casualty Association

Physicians Health Association LVI

Physicians Products Company XIV

Pinebluff Sanitarium I

Pisgah Forest Inn LVIII

P. Lorillard Company (Kent Cigarettes) XI

A. H. Robins Company XV

J. B. Roerig & Company XIX, LI

Saint Albans Sanatorium LIX

Schering Corporation XXIX

G. D. Searle & Co XXXV

Smith-Dorsey Company XVI, XVII

Smith-Kline & French Laboratories 4th Cover

St. Paul Fire and Marine Insurance LXIII

Tucker Hospital LVI

U. S. Vitamin Company Reading

Valentine Company LVII

Wachtel's Incorporated LVI

Wallace Laboratories VI, Insert, VII

Wesson Oil and Snowdrift

Sales Company IV, V

Winchester Surgical Supply Co.

Winchester-Ritch Co. I

Winthrop Laboratories X, XXXIX, XLVIII

Ury •

CHOSEN BY MEDICAL
SOCIETY OF THE STATE OF
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HOME OFFICE: 385 WASHINGTON ST., ST. PAUL, MINN.

SERVICE OFFICE: RALEIGH, NORTH CAROLINA— 323 W. MORGAN ST. TEmple 4-7458

one child has epilepsy...

even her companions might not know— if
her seizures are controlled with medication

DILANTIN

"...nowadays our approach should be, as far as possible, to protect
the patient with sufficient medicine and allow him to live as much
as possible the life of a normal child."1 Under proper medical care,
epileptic children may — and should - participate in the general phys-
ical activities of their normal playmates.-
for clinically proved results in control of seizures

i> SODIUM KAPSEALS® outstanding performance
in grand mal and psychomotor seizures:" In
the last 15 years new anticonvulsant agents
have come into clinical use but they have
not replaced diphenylhydantoin [Dilantin] as the most effective single agent
for a variety of reasons."1 DILANTIN Sodium {diphenylhydantoin sodium.
Parke-Davis) is available in several forms including Kapseals of 0.03 Gm.
and of 0.1 Gm.. in bottles of 100 and 1.000.

other members of THE PARKE-DAVIS FAMILY OF ANTICONVULSANTS

for grand mal and psychomotor seizures: PHELANTIN* Kapseals (Dilantin
100 mg., phenobarbital 30 nig., desoxyephedrine hydrochloride 2.5 mg.),
bottles of 100' for the petit mal triad: MiLONTiNri Kapseals, (phensuximide,
Parke-Davis) 0.5 Gm., bottles of 100 and 1,000; Suspension, 250 mg. per
4 cc., 16-ounce bottles. CELONTIN® Kapseals (methsuximide, Parke-Davis)
0.3 Gm., bottles of 100.

Literature supplying details of dosage and administration available on request .
Bibliography: (1) Scott, J. S.. & Kellaway, P: M. Clin. North America 42:416 (March) 1958.
(2) Ganoui?, L. D., in Green. J. R., & Steelman, H. E: Epileptic Seizures. Baltimore, Williams &
Wilkins Company. 1956, pp. 98-102. (3) Bray, P E: Pediatrics 23:151. 1959. 26.»o

PARKE-DAVIS

PARKE, DAVIS & COMPANY . Detroit 32. Michican

SflMB

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Sr^M^

^

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55&1,

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.*.«AL

IN ANXIETY-RELAXATION
RATHER THAN DROWSINESS

STELAZINF

brand of trifluoperazine

'Stelazine' has little if any soporific effect. ". . . pa-
tients who reported drowsiness as a side effect
mentioned that they did not fall asleep when they
lay down tor a daytime nap. It is quite possible that,
in some instances, 'drowsiness' was contused with
unfamiliar feelings of relaxation."1

Available' tor use in everyday practice: Tablets,
1 ing., in bottles of 50 and 500; and 2 mg., in
bottles of 50.

N.B.: For information on dosage, side effects,
cautions and contraindications, sec available com-
prehensive literature, PDR, or your S.K.F. rep-
resentative.

1. Goddard. E.S. : in Trifluoperazine. Further Clini-
cal and Laboratory Studies, Philadelphia, Lea &
Febiger, 1959.

SMITH
KLINE &
FRENCH

leaders in psychopharmacettlkal research

NORTH CAROLINA

IN THIS ISSUE:

RF€Fn/£D

SYMPOSIUM ON ACUTE SURGICAL CONDITION% 3 , ,R

OF THE ABDOMEN n,..lr,

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Co-Pyronii ^««^^s

symptom-free around the clock

Each Pulvule' Co-Pyronil contains:

Histadyl® 25 mg.

a fast-acting antihistaminic

Pyronil® 15 mg.

a long-acting antihistaminic

Clopane* Hydrochloride . . 12.5 mg.

a sympathomimetic
Usual Dosage: 2 or 3 Pulvules daily. Also available as Suspension and Pediatric Pulvules.

Co-Pyronil® (pyrrobutamine compound, Lilly)

Histadyl® (thenylpyramine, Lilly)

Pyronil® (oyrrobutamine. Lilly)

Clopane® Hydrochloride (cyclopentamine hydrochloride, Lilly)

ELI LILLY AND COMPANY . INDIANAPOLIS 6, INDIANA, U. S. A.

Sfey

Table of Contents, Page II

CLINICAL REMISSION

IN A "PROBLEM" ARTHRITIC

In rheumatoid arthritis with diabetes mellitus. A 54-year-old diabetic
with a four-year history of arthritis was started on Decadron, 0.75 mg./
day, to control severe symptoms. After a year of therapy with 0.5 to
1.5 mg. daily doses of Decadron, she has had no side effects and dia-
betes has not been exacerbated. She is in clinical remission.*

New convenient b. i.d. alternate dosage schedule: the degree and extent of relief provided by
DECADRON allows tor b.i.d. maintenance dosage in many patients with so-called "chronic" condi-
tions. Acute manifestations should first be brought under control with a t.i.d. or q.i.d. schedule.

Supplied: As 0.75 mg. and 0.5 mg. scored, pentagon-shaped tablets in bottles of 100. Also available
as Injection DECADRON Phosphate. Additional information on DECADRON is available to physicians
on request. DECADRON is a trademark of Merck & Co., Inc.

•From a clinical investigator's report to Merck Sharp & Dohme.

Decadron*

Dexamethasone

TREATS MORE PATIENTS MORE EFFECTIVELY

(ffsra MERCK SHARP & DOHME • Division of Merck & Co., INC., West Point, Pa.

I i

T'

KlPSrj

LK

<;

-.j

August, 1960

ADVERTISEMENTS

A Sanitarium for Rest Under Medical Supervision, and Treatment of Nervous
and Mental Diseases, Alcoholism and Drug Addiction.

The Pinebluff Sanitarium is situated in the sandhills of North Carolina in a 60-acre park
of long pines. It is located on U. S. Route 1, six miles south of Pinehurst and Southern
Pines. This section is unexcelled for its healthful climate.

Ample facilities are afforded for recreational and occupational therapy, particularly out-
of-doors.

Special stress is laid on psychotherapy. An effort is made to help the patient arrive at
an understanding of his problems and by adjustment to his personality difficulties or
modification of personality traits to effect a cure or improvement in the disease. Two resident
physicians and a limited number of patients afford individual treatment in each case.

For further information write:

The Pineblu££ Sanitarium, PinebiuSf, N. c.

Malcolm D. Kemp, M.D.

Medical Director

RITTER ... the finest for

the profession!

The Ritter Universal Table enables you to treat more
patients more thoroughly, with less effort in less time.
Here is the ultimate in examining table flexibility . . .
easy to position . . . more comfortable for patients.

The L-F BasalMeter of-
fers fast, accurate BMR
testing. No graph, chart
or slide rule needed.
Patient's BM rate is
read directly on meter.

WINCHESTER

"CAROLINAS' HOUSE OF SERVICE"

WINCHESTER SURGIICAL SUPPLY CO. WINCHESTER-RITCH SURGICAL CO.

119 East 7th Street Charlotte, N. C. 421 West Smith St. Greensboro, N. C.

NORTH CAROLINA MEDICAL JOURNAL

August, 1960

North Carolina Medical Journal

Official Organ of
The Medical Society of the State of North Carolina

Volume 21
Number 8

AUGUST, 1960

75 CENTS A COPY
$5.00 A YEAR

CONTENT

Original Articles

Symposium on Acute Surgical Conditions of
the Abdomen

Acute Abdominal Pain Associated with
Vascular Emergencies — Gordon M. Car-
ver, Jr., M.D 313

Diagnosis and Treatment of Intussuscep-
tion in Infants and Children — Louis
Shaffner, M.D 318

Diagnosis and Treatment of Acute Diver-
ticular Disease of the Colon — E. Jackson
Dunning, M.D 322

Diagnosis and Treatment of Acute Chole-
cystitis—William W. Shingleton, M.D. . 326

Acute Surgical Conditions Associated with
Pelvic Endometriosis — Robert A. Ross,
M.D 329

Medical and Hospital Costs of the Aged — A
Current Appraisal — Walter Polmer, Ph.D. 330

Leptospirosis: Report of a Case — William A.
Leonard, Jr., M.D 339

Medical Problems Facing Congress — Sam J.
Ervin, Jr 335

Salmonella and Shigella Infections Found in
One Hundred Ninety-five Cases of Acute
Diarrhea— E. R. Caldwell, Jr., and E. A.
Abernathy, M.D 342

EDITORIALS

Naming New Drugs 343

The Arthritis Hoax 344

Psychiatric Patients in a General Hospital . 344

Three Corrections 344

Dr. Preston — New Editor of Health Bulletin . 345

"You Are Old, Father William" 345

North Carolina's Committee on the Medical
Credit Bureaus 345

COMMITTEES AND ORGANIZATIONS

North Carolina Board of Medical Examiners:
The Biennial Registration 346

Bulletin Board

Coming Meetings 346

New Members of the State Society .... 347

News Notes from the University of North
Carolina School of Medicine 347

News Notes from the Bowman Gray School
of Medicine of Wake Forest College . . . 348

News Notes from the Duke Uuniversity Med-
ical Center 349

North Carolina Academy of General Practice 349

County Societies 349

News Notes 350

Announcements 350

Book Reviews

354

The Month in Washington

355

In Memoriam

356

Classified Advertisements

354

Index to Advertisers

LI

Entered as second-class matter January 2. 1940, at the Post Office at Winston-Salem, North Carolina, under the Act of
August 24. 1912. Copyright 1960 by the Medical Society of the State of North Carolina.

v*^-i-:>^-t;/,r^;^:-^;

(SYRUP OF CHLORAL

HYDRATE )

A palatable chloral hydrate syrup
containing 10 grains in each teaspoonful.

JONES and VAUGHAN
Richmond 26, Virginia

Another
significant statement

concerning
the role of fats

L^f

FREE: Wesson recipes, available in quantity for your patients, show how to

prepare meats, seafoods, vegetables, salads and desserts with po/y-unsaturated
vegetable oil Request quantity needed from The Wesson People,

Dept. N, 210 Baronne St., New Orleans 12, La.

Dietary Linoleic Acid and Linoleate— Effects in Diabetic and
Nondiabetic Subjects with and without Vascular Disease

\A paper by Laurance W. Kinsell, M.D., et al.,
{excerpted from Diabetes — The Journal of the
I American Diabetes Association, May-June 1959

*' Linoleic acid as the major 'hypocholesterolemic

\agent' in vegetable fats. The question has been

raised as to the mechanism of lowering of the

plasma lipids by a variety of vegetable fats.

Among the entities present in or absent from

vegetable fat which have been considered are:

(a) the absence of cholesterol; (b) the presence

of certain vegetable sterols; (c) the presence of

certain vegetable phospholipids; (d) the nature

(of one or more of the fatty acids present; (e)

I the presence of trace materials.

h the diet

..

:The absence of cholesterol has been excluded as

I a major factor.5a Phospholipids, if they contain
la sufficient quantity of unsaturated fatty acids
imay produce a striking reduction. In our experi-
ence thus far saturated phospholipids fail to pro-
duce such an effect.7

Beveridge and his associates believe that veg-
■letable sterols, particularly beta-sitosterol, are re-

II sponsible to a significant degree for the cholesterol-
||lowering effect.8 In our experience the vegetable

I sterols have a relatively weak and unpredictable
effect of this sort.
Since the fatty acids of animal fats are pre-
dominantly saturated, and the fatty acids of most
! vegetable fats are predominantly polyunsaturated,
|with linoleic acid as the major component of the
vegetable fats which lower cholesterol and other
lipids, the question arises whether linoleic acid
llper se is capable of lowering plasma lipids. As
reported previously7 this is indeed the case. In a
recent study in a young male with peripheral
atherosclerosis in association with elevation of
plasma cholesterol and of total lipids, ethyl lino-
i leate produced a greater fall in the plasma lipid
| levels than had moderate amounts of natural
sources of unsaturated fat. Linoleic acid, there-
fore, appears to be the most important single
lipid-lowering component of vegetable fat.
* * *

Significantly higher levels of cholesterol were
observed during oleate administration than dur-
ing administration of equal amounts of linoleate.

The relatively low cholesterol values during the
second oleate period may have been related to
linoleate stored in fat depots. The fatty acid com-
position of the cholesterol esters reflected the
fat which was fed, i.e., the mono-enoic+ acid
content averaged more than 40 per cent during
oleate feeding and less than 20 per cent during
linoleate ingestion. Essentially, a mirror image
of this resulted during linoleate feeding, at which
time di-enoic acid predominated.

The data presented in this paper appear to estab-
lish that linoleic acid administered either as puri-
fied ethyl ester or as naturally occurring fat, in
sufficient quantity, in properly constructed diets,
will reduce plasma lipids to normal levels. The
amount of linoleic acid required appears to bear
a direct relationship to the amount of saturated
fat included in the diet. Linoleic acid require-
ment may also bear a significant relationship to
the amount of atherosclerosis present.

The transition from evaluation of the effect of
dietary entities upon plasma lipids, to the evalua-
tion of the effect of such materials upon vascular
disease is difficult. However, such evaluation is
not impossible. The requisites are adequate meas-
uring sticks and well-controlled studies of suffi-
cient duration. The duration of observation of
effects of unsaturated fat in diabetic and non-
diabetic patients with vascular disease is in no
instance more than five years, and in the majority
of instances, less than three. Our present impres-
sion is that improvement has occurred in some
patients with atherosclerosis and with diabetic
retinal and renal disease which was more than
we would have anticipated in terms of the natural
course of the disease. However, since it is well
known that major fluctuations in these diseases
can occur in individuals receiving no treatment,
we believe it is appropriate at this time to say
that no untoward effects appear to result when
one prescribes diets containing large amounts of
unsaturated fat for patients with such diseases,
and it is not impossible that beneficial effects may
be associated with such diets."
# » -*

5a Kinsell. L.W., Partridge, J. W., Boling, L.. Margen. S..
and Michaels. G.D.: Dietary modification of serum cholesterol
and phospholipid levels. J. Clin. Endocrinol and Met. 12:909,
1952.

7 Kinsell, L. W., Friskey, R., Splitter, S.. Michaels. G. D. :
Essential fatty acids, lipid metabolism, and atherosclerosis.
Lancet 1:334, 1958.

8 Beveridge, J.M., Connell. W.F., Firstbrook, J. B.. Mayer,
G.A., and Wolfe. M.J. : Effects of certain vegetable and animal
fats on plasma lipids of humans. J. Nutrition 56:311, 1955.

7 Mono-enoic (mono-unsaturated) acid is presumably synony-
mous under these conditions with oleic acid and di-enoic (di-
unsaturated) acid with linoleic acid

Where a vegetable (salad) oil is medically recommended for a cholesterol
depressant regimen, Wesson is unsurpassed by any readily available brand.

WESSON'S IMPORTANT CONSTITUENTS

Wesson is 100% cottonseed oil . . . winterized and of selected quality Palmitic, stearic and myristic glycerides (saturated) 25-30%

Linoleic acid glycerides (poly-unsaturated) 50-55% Phytosterol (predominantly beta sitosterol) 0.3-0.5%

; Oleic acid glycerides (mono-unsaturated) 16-20% Total tocopherols 0.09-0.12%

Total unsaturated 70-75% Never hydrogenated— completely salt free

VI

NORTH CAROLINA MEDICAL JOURNAL

August, 1960

Carrying on

congestion-free

with fast-acting

NASAL SPRAY

At the first allergic sneeze, two inhalations from the NTz Nasal Spray act speedily to bring excep-
tional relief of symptoms. The first spray shrinks the turbinates and enables the patient to breathe
through his nose again. The second spray, a few minutes later, opens sinus ostia for essential
ventilation and drainage. Excessive rhinorrhea is reduced. nTz is well tolerated and provides safe
"inner space" without causing chemical harm to the respiratory tissues.
NTz is a balanced combination of three thoroughly evaluated compounds:
;N eo-Synephrine® HCI, 0.5% to shrink nasal membranes and sinus ostia and provide

inner space
(T henfadil® HCI, 0.1% to provide powerful topical antiallergic action and lessen rhinorrhea
(Z ephiran^1 CI, 1:5000 (antibacterial wetting agent and preservative) to promote spread and
penetration of the formula to less accessible nasal areas
HTzis supplied in leakproof, pocket size, squeeze bottles of 20 cc. and in bottles of 30 cc. with dropper.

QUICK SYMPTOMATIC RELIEF OF HAY FEVER OR PERENNIAL RHINITIS

nT;, Neo-Synephrine (brand of phenylephrine), Thenfadtl (brand of thenyldiamine) and
Zephiran (brand of benzalkonium, as chloride, refined), trademarks reg. U. S. Pat. Off.

UljinWiob

LABORATORIES
New York 18, N. Y.

August, 1960

ADVERTISEMENTS

VII

DIAGNOSIS

New (2nd) Edition!

Frederick and Towner-
The Office Assistant
in Medical Practice

This handy manual will save you time and
money in training an efficient office assistant. It
is packed with help on every phase of her job
— as receptionist, secretary, nurse, bookkeeper
and technician.

These are the kind of problems on which your
assistant will find valuable help: What should you
say in a series of collection letters? How do you
keep a narcotics inventory? What should you
remember in preparing the doctor's bag? To
whom do the patient's medical records belong?
How do you sharpen a hypodermic needle?
How do you prepare a patient for pelvic ex-
amination? etc.

The authors have brought this new edition fully
up-to-date. The chapter on Bookkeeping is ex-
panded with many new illustrations on the
"write-it-once" bookkeeping system, etc. The
chapter on Instruments is now much more de-
tailed and clearly illustrated. Much new help is
added on sterilization.

By Portta M. Frederick, Instructor, Medical Office Assist-
ing, Long Beach City College; and Carol Towner, Director
of Special Services, Communications Division, American
Medical Association. 407 pages, 5H" x 8", illusttated. S5.25.

New (2nd) Edition!

2 Companion Volumes

by Paul Williamson, M. D.

Office Diagnosis

New! Written from the author's long experience
in general practice, this book offers sound, ready-to-
use advice on solving the family physician's daily
diagnostic problems. With the help of simple line
illustrations, Dr. Williamson informally details those
diagnostic techniques that can be performed right
in your own office.

97 important signs and symptoms are discussed. Be-
ginning with symptomatic evidence, the author takes
you back to its possible causes to help you arrive
more easily at a tenable diagnosis. You will find
symptoms such as headache, hypertension, papular
rash, anorexia, cough, cyanosis, heart murmurs, con-
stipation, incontinence, pain in the breasts, leu-
korrhea clearly covered. Where pertinent, Dr.
Williamson offers definitive help on: etiology, his-
tory taking, general examination of the patient,
x-ray, laboratory tests, drug therapy, diagnostic pit-
falls to avoid, complications, etc.

If you are familiar with Williamson' s Office Pro-
cedures (below), you know the kind of useful,
down-to-earth help to expect from this new volume.

By Paul Williamson, M.D. 470 pages, 8"xll", with 350
illustrations. $12.50. New.'

Office Procedures

Dr. Williamson fully discusses 379 useful manage-
ment procedures for 171 common disorders and
diseases in this unusual book. Aided by crystal clear
illustrations, he tells you exactly how to best proceed
with those techniques that can be safely and effec-
tively performed in your own office. You will find
precise descriptions of: how to irrigate the ear; how
to pack for nosebleed; how to construct and fit a
truss in inguinal hernia; how to treat muscle tears
and ruptures; how to retrieve a retracted tendon;
how to properly incise and drain a breast abscess; etc.

By Paul Williamson, M.D. 412 pages, 8"xll", with 1100
illustrations. 512.50. Published 1955.

Order from W. B. SAUNDERS CO M PAN Y-West Washington Sq., Phila. 5 1

Please send me the following books and charge my account :

□ Williamson's Office Diagnosis, $12.50 Q Williamson'sOfficeProcedures,$12.50
□ Frederick & Towner's The Office Assistant, $5.25

Name

Address SJG-860.

VIII NORTH CAROLINA MEDICAL JOURNAL August, 1060

Medical Society of the State of North Carolina

OFFICERS — 1960

President — Amos Neill Johnson, M.D., Garland

President Elect — Claude B. Squires, M.D., 225 Hawthorne Lane, Charlotte
Past President — John C. Reece, M.D., Grace Hospital, Morganton
First Vice-President — Theodore S. Raiford, M.D., Doctors Building, Asheville
Second Vice-President — Charles T. Wilkinson, M.D., Wake Forest
Secretary — John S. Rhodes, M.D., 700 West Morgan Street, Raleigh
Executive Director — Mr. James T. Barnes, 203 Capital Club Building, Raleigh
The President, Secretary and Executive Director are members ex-officio

of all committees
Speaker-House of Delegates — Donald B. Koonce, M.D., 408 N. 11th St., Wilmington
Vice-Speaker-House of Delegates — E. W. Schoenheit, M.D., 46 Haywood St., Asheville

COUNCILORS — 1958 - 1961

First District— T. P. Brinn, M.D., 118 W. Market Street, Hertford

Vice Councilor — Q. E. Cooke, M.D., Murfreesboro
Sccoyid District — Lynwood E. Williams, M.D., Kinston Clinic, Kinston

Vice Councilor — Ernest W. Larkin, Jr., M.D., 211 N. Market St., Washington
Third District — Dewey H. Bridger, M.D., Bladenboro

Vice Councilor — William A. Greene, M.D., 104 E. Commerce St., Whiteville
Fourth District — Edgar T. Beddingfield, Jr., M.D., P.O. Box 137, Stantonsburg

Vice Councilor — Donnie H. Jones, M.D., Box 67, Princeton
Fifth District— Ralph B. Garrison, M.D., 222 N. Main Street, Hamlet

Vice Councilor — Harold A. Peck, M.D., Moore County Hospital, Pinehurst
Sixth District — George W. Paschal, Jr., M.D., 1110 Wake Forest Rd., Raleigh

Vice Councilor— Rives W. Taylor, M.D., P.O. Box 1191, Oxford
Seventh District —

Vice Councilor — Edward S. Bivens, M.D., Stanly County Hospital, Albemarle
Eighth District— -Merle D. Bonner, M.D., 1023 N. Elm Street, Greensboro

Vice Councilor — Harry L. Johnson, M.D., P.O. Box 530, Elkin
Ninth District — Thomas Lynch Murphy, M.D., 116 Rutherford St., Salisbury

Vice Councilor — Paul McNeely Deaton, M.D., 766 Hartness St., Statesville
Tenth District — William A. Sams, M.D., Main Street, Marshall

Vice Councilor — W. Otis Duck, M.D., Drawer 517, Mars Hill

DELEGATES TO THE AMERICAN MEDICAL ASSOCIATION

Elias S. Faison, M.D., 1012 Kings Drive, Charlotte

C. F. Strosnider, M.D., 111 E. Chestnut Street, Goldsboro

Millard D. Hill, M.D., 15 W. Hargett Street, Raleigh

William F. Hollister, M.D., (Alternate), Pinehurst Surgical Clinic, Pinehurst

Joseph F. McGowan, M.D., (Alternate), 29 Market Street, Asheville

Wm. McN. Nicholson, M.D., (Alternate), Duke Hospital, Durham

SECTION CHAIRMEN 1959-1960

General Practice of Medicine — Julius Sader, M.D., 205 East Main Street, Brevard
Internal Medicine — Walter Spaeth, M.D., 116 South Road, Elizabeth City
Ophthalmology and Otolaryngology — Charles W. Tillett, Jr., M.D., 1511 Scott

Avenue, Charlotte
Surgery — James E. Davis, M.D., 1200 Broad Street, Durham
Pediatrics — William W. Farley, M.D., 903 West Peace Street, Raleigh
Obstetrics & Gynecology — H. Fleming Fuller, M.D., Kinston Clinic, Kinston
Public Health and Education — Isa C. GRANT, M.D., Box 949, Raleigh
Neurology & Psychiatry — Myron G. Sandifer, M.D., N. C. Memorial Hospital,

Chapel Hill
Radiology — Isadore Meschan, M.D., Bowman Gray School of Medicine,

Winston-Salem
Pathology — Roger W. Morrison, M.D., 65 Sunset Parkway, Asheville
Anesthesia — Charles E. Whitcher, M.D., Route 1, Pfafftown
Orthopedics & Traumatology — Chalmers R. Carr, M.D., 1822 Brunswick Avenue,

Charlotte
Student AM A Chapters — Mr. John Feagin, Duke University School of Medicine,

Durham

\

Save a

family breadwinner

lost time from

LOW BACK PAIN

with

TmncopaF

Brand of chlormezanone

effective oral skeletal

muscle relaxant
and mild tranquilizer

Trancopal enables patients
to resume their duties in
from one to two days.

In a recent study of Trancopal in industrial medi-
cine,1 results from treatment with this "tranquil-
axant" were good to excellent in 182 of 220
patients with muscle spasm or tension states. From
clinical examination of those patients in whom
muscle spasm was the main disorder, ". . . it was
apparent that the combined effect of tran-
quilization and muscle relaxation enabled
them to resume their normal duties in
from twenty-four to forty-eight hours.
... It is our clinical impression that
Trancopal is the most effective oral
skeletal muscle relaxant and mild
tranquilizer currently available."1
Side effects occurred in only 12 patients, and:
"No patient required that the dosage be reduced
to less than one Caplet three times daily because
of intolerance."1

Clinical results with TvSttlCOpsJf

Excellent

Good

Fair

Poor

Total

,0W BACK SYNDROMES

Acute low back strain

25

19

8

6

58

Chronic low back strain

11

5

1

1

18

"Porters' syndrome"*

21

5

1

1

28

Pelvic fractures

2

1

—

—

3

IECK SYNDROMES

Whiplash injuries

12

6

2

1

21

Torticollis, chronic

6

2

3

2

13

ITHER MUSCLE SPASM

Spasm related to trauma

15

6

1

—

22

Rheumatoid arthritis

—

18

2

1

21

Bursitis

2

6

1

—

9

ENSION STATES

18

2

4

3

27

OTALS

112
(51%)

70
(32%)

23

(10%)

15
(7%)

220

(100%)

♦Over-reaching in lifting heavy bags resulting in sprain of upper, middle, and lower back muscles.

Dosage: Adults, 200 or 100 rag. orally three or four times daily.

Relief of symptoms occurs in from fifteen to thirty minutes and lasts from four to six hours.

How Supplied: Trancopal Caplets®

200 mg. (green colored, scored), bottles of 100.
100 mg. (peach colored, scored), bottles of 100.

1. Kearney, R. D.: Current Therap. Res. 2:127, April, 1960.

?06M Trancopa! (brand of chlormezanone) and Caplets, trademarks reg. U. S. Pat. Off.

LABORATORIES, New York 1 8, N. Y.

she calls it "nervous indigestion"

diagnosis: a wrought-up patient with a functional
gastro-intestinal disorder compounded by inade-
quate digestion, treatment: reassurance first, then
medication to relieve the gastric symptoms, calm
the emotions, and enhance the digestive process.
prescription: new Donnazyme— providing the mul-
tiple actions of widely accepted Donnatals" and
Entozyme^— two tablets t.i.d., or as necessary.

Each Donnazyme tablet contains
—In the gastric-soluble outer layer: Hyoscyamine
sulfate, 0.0518 mg.; Atropine sulfate, 0.0097 mg.;
Hyoscine hydrobromide, 0.0033 mg.; Phenobarbi-
tal (Vs gr.), 8.1 mg.; and Pepsin, N. F., 150 mg.
In the enteric-coated core: Pancreatin, N. F., 300
mg., and Bile salts, 150 mg.

ANTISPASMODIC - SEDATIVE - DIGESTANT

DONNAZYME

A. H. ROBINS COMPANY, INCORPORATED . RICHMOND 20, VIRGINIA

August, 1960

ADVERTISEMENTS

XI

ALL OVER AMERICA!

KENT with the MICRONITE FILTER

IS SMOKED BY
MORE SCIENTISTS and EDUCATORS

than any other cigarette!*

FIVE TOP BRANDS OF CIGARETTES
SMOKED BY AMERICAN SCIENTISTS

KENT.

BRAND "A" I
BRAND "G" ■
BRAND "F"

BRAND "B 4

15.3%
10.5%
7.9%
7.6%

7.3%

\ \1

This does not constitute a
professional endorsement
of Kent. But these men, like
millions of other Kent smokers,
smoke for pleasure, and choose
their cigarette accordingly.

The rich pleasure of smoking
Kent comes from the flavor
of the world's finest natural
tobaccos, and the free and
easy draw of Kent's famous
Micronite Filter.

If you would like the booklet, "The Story of Kent", for your
own use, write to: P. Lorillard Company — Research De-
partment, 200 East 42nd Street, New York 17, New York.

For good smoking taste, WM [Mil?

it makes good sense to smoke IrXiHINllll

^e Results ol a continuing sludy of cigarette preferences, conducted oy O'Brien Sherwood Associates, N.Y.. N.Y.
A PRODUCT OF P LORIUARD COMPANY FIRST WfTW THE FINEST CIGARETTES THROUGH LORILLARD RESEARCH

C I940.F lOniAOCCt

XII

NORTH CAROLINA MEDICAL JOURNAL

August, 1960

in respiratory allergies

TRISTACOMP

Orally-administered triple antihistamines plus two effec-
tive decongestant agents— to prevent histamine-induced
dilatation and exudation of the nasal and paranasal
capillaries and to help contract already engorged capil-
laries, providing welcome relief from rhinorrhea, stuffy
noses, sneezing and sinusitis.

convenient
dosage forms

TRISTACOMP TABLETS

Each sustained release tablet:

Chlorpheniramine Maieafe 2.5 mg.

Phenyjtoloxamine Citrate 12.5 mg,

Pyrifamine Maleate 25.0 mg.

Phenylephrine Hydrochloride 10.0 mg.

Phenylpropanolamine Hydrochloride 30.0 mg.

Dosage: One tablet morning and night

TRISTACOMP LIQUID

£ach 5 cc feaspaonfu/ provides one-fourth the above

formula.

Dosage: Adults, two teaspoonfuls three to four times

daily. Children, one-ha/f to fwo reaspoonfy/s,

according fo age.

c c

jsual medications
act only here

olief in MAY FKV^

iSn

NEW

• •

iflSt. -

$»«>,

acts here

to relieve both nasal

and chest discomfort

M

AV

provides both

/upper
an

respiratory decongestion
and bronchial decongestion

Many hay fever patients also experience chest discomfort. For these patients,

new ISOCLOR provides relief along the entire respiratory tract.

COMBINES the nasal and bronchial decongestant action of d-isoephedrine with

the histamine blocking action of chlorpheniramine.

RELIEVES the discomforts of rhinorrhea, itching, sneezing, hyperlacrimation

and post nasal drip— let s the patient get a full night's rest— with minimal daytime

drowsiness, CNS or pressor stimulation.

TABLETS AND SYRUP for adults and children . . .
COMPOSITION: Per tablet Per 5 ml. syrup

Chlorpheniramine maleate 4 mg. 2 mg.

d-lsoephedrine HCI 25 mg. 12.5 mg.

DOSE: Tablets: One tablet 3 or 4 times daily. Syrup: Children: 3-6 yrs.
Vz tsp. t.i.d.; 6-12 yrs. 1 tsp. t.i.d.; Adults: 2 tsp. t.i.d.

AVAILABLE: Tablets: Bottles of 100. Syrup: Pint bottles.

ARNAR-STONE

Laboratories, Inc.
Mt. Prospect, Illinois

XIV

NORTH CAROLINA MEDICAL JOURNAL

August, 19C.0

Naturetin

Squibb Benzydroflumethiazide

NaturetincK

Squibb Benzydroflumethiazide with Potassium Chloride

"...a safe and extraordinarily
effective diuretic..."1

Naturetin — reliable therapy in edema and
hypertension — maintains a favorable uri-
nary sodium-potassium excretion ratio . . .
retains a balanced electrolytic pattern:

"... the increase in urinary output occurs

promptly . . . " l
"... the least likely to invoke a negative

potassium balance . . ."'
"... a dose of 5 nig. of Naturetin produces a

maximal sodium loss."2
"... an effective diuretic agent as manifested

by the loss in weight . . . "3
"... no apparent influence of clinical

importance on the serum electrolytes

or white blood count."3
"... no untoward reactions were attributed

to the drug."4
Although Naturetin causes the least serum
potassium depletion as compared with other
diuretics, supplementary potassium chloride in
Naturetin c K provides added protection when
treating hypokalemia-prone patients; in con-
ditions where likelihood of electrolyte imbal-
ance is increased or during extended periods
of therapy.

Numerous clinical studies confirm the effec-
tiveness1'1'' of Naturetin as a diuretic and
antihypertensive — usually in dosages of 5
mg. per day.

■ the most potent diuretic, mg. for mg.— more
than 100 times as potent as chlorothiazide

■ prolonged action — in excess of 18 hours ■
maintains its efficacy as a diuretic and anti-
hypertensive even after prolonged or increased
dosage use ■ convenient once-a-day dosage —
more economical for patients ■ low toxicity —
few side effects— low sodium diets not necessary

■ not eontraindicated except in complete renal
shutdown ■ in h ypertension— significant lower-
ing of the blood pressure. Naturetin may be
used alone or with other antihypertensive drugs
in lowered doses.

Supplied: Naturetin Tablets, 5 mg. (scored)
and 2.5 mg. Naturetin cK (5 c 500) Tablets
(capsule-shaped) containing 5 mg. benzydro-
flumethiazide and 500 mg. potassium chloride.
Naturetin c K (2.5 c 500) Tablets (capsule-
shaped) containing 2.5 mg. benzydroflumethia-
zide and 500 mg. potassium
chloride. SQUIBB

References: 1. David, N. A.: Porter, G. A., and Gray, R. H.: Monographs on Therapy S:60 (Feb.) I960.
2. Stenberg-, E. S., Jr.; Benedetti, A., and Forsham, P. H.: Op. clt. 5:46 (Feb.) 1960. 3. Fuchs, M.; Moyer,
J. H., and Newman, B.E.: Op. clt. 5:55 (Feb.) 1960. 4. Marriott. H. J. L., and Schamroth, L.: Op. cit. 5:14
(Feb.) 1960. 5. Ira, G. H., Jr.; Shaw, D. M., and Bogdonoff, M. D.: North Carolina M. J. 21:19 (Jan.) 1960.
6. Cohen, B. M.: M. Times, to be published. 7. Breneman, G. M., and Keyes, J. W.: Henry Ford Hosp. M. Bull.
7:281 (Dec.) 1959. 8. Forsham, P. H.: Squibb Clin. Res. Notes 2:5 (Dec.) 1959. 9. Larson, E.: Op. cit. 2:10
(Dec.) 1959. 10. Klrkendall, W. M.: Op. clt. 2:11 (Dec.) 1959. 11. Yu, P. N.: Op. cit. 2:12 (Dec.) 1959.
12. Weiss, S.; Weiss, J., and Weiss, B.: Op. clt. 2:13 (Dec.) 1959. 13. Moser, M.: Op. cit. 2:13 (Dec.) 1959.
14. Kahn, A., and Greenblatt, I. J.: Op. cit. 2:15 (Dec.) 1959. 15. Grollman, A.: Monographs on Therapy
9:1 (Feb.) 1960. 'naturetin' is a squibs trademark.

^..SQi "&■ W

Squibb Quality— the
Priceless Ingredient

PAPAIN

IS THE

KEY

to complete, thorough
vaginal cleansing

mucolytic, acidifying,
ihysiologic vaginal douche

The papain content of Meta Cine is the key
•eason why it effects such complete cleansing of
he vaginal vault. Papain is a natural digestant,
md is capable of rendering soluble from 200-
!00 times its weight of coagulated egg albumin.
n the vagina, papain serves to dissolve mucus
jlugs and coagulum.

Vteta Cine also contains lactose — to promote
growth of desirable Doderlein bacilli — and
nethyl salicylate, eucalyptol, menthol and
;hlorothymol, to stimulate both circulation and
normal protective vaginal secretions. Meta
fine's pleasant, deodorizing, non-medicinal fra-
grance will meet your patients' esthetic demands.

Supplied in 4 oz. and 8 oz. containers, and in
Doxes of 30 individual-dose packets. Dosage:
I teaspoonfuls, or contents of 1 packet, in 2
quarts of warm water.

EH

:i:»\yten

BRAYTEN PHARMACEUTICAL COMPANY Chattanooga 9, Tennessee

XVI NORTH CAROLINA MEDICAL JOURNAL August, 1960

Proven

in over five years of clinical use and
more than 750 published clinical studies

Effective

for relief of anxiety and tension

Outstandingly Safe

• simple dosage schedule produces rapid, reliable
tranquilization without unpredictable excitation

• no cumulative effects, thus no need for difficult
dosage readjustments

• does not produce ataxia, change in appetite or libido

• does not produce depression, Parkinson-like symptoms,
jaundice or agranulocytosis

• does not impair mental efficiency or normal behavior

for

the
tense
and
nervous
patient

Despite the introduction in recent years of "new and dif-
ferent" tranquilizers, Miltown continues, quietly and
steadfastly, to gain in acceptance. Generically and under
the various brand names by which it is distributed,
meprobamate (Miltown) is prescribed by the medical
profession more than any other tranquilizer in the world.

The reasons are not hard to find. Miltown is a known drug,
evaluated in more than 750 published clinical reports. Its
few side effects have been fully reported; there are no
surprises in store for either the patient or the physician.
It can be relied upon to calm anxiety and tension quickly
and predictably.

Usual dosage: One or two
400 mg. tablets t.i.d.
Supplied : 400 mg. scored tablets,
200 mg. sugar-coated tablets;
or as meprotabs*— 400 mg.
unmarked, coated tablets.

Miltown

meprobamate (Wallace}

" WALLACE LABORATORIES / New Brunswick, N. J.

"Gratifying" relief from

for your patients with
'low back syndrome' and
other musculoskeletal disorders

POTENT muscle relaxation
EFFECTIVE pain relief
SAFE for prolonged use

stiffness and pain

^IdXllyllli^ relief from stiffness and pain

in 106-patient controlled study

(as reported inJ.A.M.A., April 30, 1960)

"Particularly gratifying was the drug's [Soma's]
ability to relax muscular spasm, relieve pain, and
restore normal movement ... Its prompt action,
ability to provide objective and subjective assist-
ance, and freedom from undesirable effects rec-
ommend it for use as a muscle relaxant and anal-
gesic drug of great benefit in the conservative
management of the 'low back syndrome'."

Kestler, O.: Conservative Management of "Low Back Syndrome" ,

J.A.M.A. 172: 2039 (April 30) I960.

FASTER IMPROVEMENT- 79% complete or marked

improvement in 7 days (Kestler)

EASY TO USE— Usual adult dose is one 350 mg. tablet
three times daily and at bedtime.

SUPPLIED: 350 mg., white tablets, bottles of 50.

For pediatric use, 250 mg., orange capsules, bottles of 50.

Literature and samples on request.

(CARISOPRODOL, WALLACE)

WALLACE LABORATORIES, CRANBURY, NEW JERSEY

9 * V8

? n

s** s s * s

?« * ?s??

S 8 f t *
$:
8
8
888 8 8888 8
8
8
8

GONORRHEA IS ON THE MARCH AGAIN...

a new timetable for recovery:

only six capsules of TETREX can cure a male patient with gonorrhea in just one day*

U.S. PAT. NO. 2, 79 1,609

THE ORIGINAL TETRACYCLINE PHOSPHATE COMPLEX

TETREX CAPSULES. 250 mg. Each capsule contains:
TETREX (tetracycline phosphate complex equivalent to
tetracycline HCI activity) - 250 mg.
DOSAGE: Gonorrhea in the male -Six capsules ol
TETREX in 3 divided doses, in one day.

* Marmell, M-, and Prigot, A.: Tetracycline phosphate complex in the treat-
ment of acute qonococcal urethritis In men. Antibiotic Med. & Clin. Ther.
6:108 (Feb.) 1959.

BRISTOL LABORATORIES,

SYRACUSE. NEW YORK

August, 1960 ADVERTISEMENTS XIX

I

1

Major Hospital Policy

Pays up to $10,000.00 for each member of your family,
subject to deductible you choose

Deductible Plans available:

$100.00
$300.00
$500.00

!

Business Expense Policy

Covers your office overhead while you
are disabled, up to $1,000.00 per month

I

% approved by

i

The Medical Society of North Carolina

| for Its Members

I

I

Write or Call
4. for information

Ralph J. Golden Insurance Agency

I Ralph J. Golden Associates Henry Maclin, IV j

I Harry L. Smith John Carson I

I |

108 East Northwood Street

Across Street from Cone Hospital

GREENSBORO, N. C.

Phones: BRoadway 5-3400 BRoadway 5-5035

I I

XX

NORTH CAROLINA MEDICAL JOURNAL

August, 1960

Squibb Announces

new chemically improved penicillin
which provides the highest blood
levels that are obtainable with oral
penicillin & — ^^ — m therapy

As a pioneer and leader in penicillin therapy
for more than a decade, Squihb is pleased
to make Chemipen, a new .chemically im-
proved oral penicillin, available for clinical use

With Chemipen it becomes possible as well as
convenient for the physician to achieve and main- ■,
tain higher blood levels — with greater speed — than \
those produced with comparable therapeutic doses of
potassium penicillin V. In fact, Chemipen is shown to
have a 2:1 superiority in producing peak blood levels
over potassium penicillin V.*

Extreme solubility may contribute to the higher blood
levels that are so notable with Chemipen.* Equally nota-
ble is the remarkable resistance to acid decomposition
(Chemipen is stable at 37CC. at pH 2 to pH 3). which
in turn makes possible the convenience of oral treatment.

And the economy for your patients will be of
particular interest — Chemipen costs no more
than comparable penicillin V preparations.

Dosage: Doses of 125 mg. (200,000 u.) or

250 mg. (400.000 u. ) . t.i.d.. depending on the

severity of the infection. The usual precautions

0t/ must be carefully observed with Chemipen, as with

all penicillins. Detailed information is available on

request from the Professional Service Department.

Supply: Chemipen Tablets of 125 mg. (200.000 u.) and

250 mg. (400.000 u.l, bottles of 24 tablets. Chemipen

Syrup (cherry-mint flavored, nonalco- SQUIBB

holic 1.125 mg. per 5 cc. 60 cc. bottles. ^SK

"Knudsen. E. T. and Rolinson. G. N.: ^joSf -<**

Lancet 2.T105 (Dec. 19) 1959. •.i'.";:,.'.'.";<i.'.<. Pricdai Uptiiai

THE ORIGINAL potassium phenethicillin

TV

^r

V

jar

....>

L i

~\

I

J

(POTASSIUM PENIGILLIN-152)

.tha

r'i ! ;: \-\ ': >

xi levels orally

intramuscular pen

A dosage form to meet the individual
requirements of patients of all ages in home,
office, clinic, and hospital:

Syneiffin Tablets— 250 nig. . . . Syncillin Tablets - 125 mg.
Syncillin for Oral Solution— 60 ml. bottles— when reconstituted,

125 nig. per 5 ml.
Syneillin Pediatric Drops — 1 . 5 Gin . bottles. Calibrated dropper

delivers 125 nig.

Complete information on indications, dosage and precautions is included in the official circular accompanying each package.

BRISTOL LABORATORIES, SYRACUSE, NEW YORK {( biustol

THE

REALMS

OF THERAPY

PASSPORT

TO

TRANQUILITY

«*?~~5>-.

ATTAINED
WITH

ATA RAX

(brand of hydroxyzine)

^

Special Advantages

unusually safe; tasty syrup,
10 mg. tablet

well tolerated by debilitated
patients

useful adjunctive therapy for
asthma and dermatosis; par-
ticularly effective in urticaria

\V IN

V HYPEREMOTIVE
ADULTS £\

does not impair mental acuity

Y World-wide record of effectiveness-over 200 labora-
tory and clinical papers from 14 countries.
Widest latitude of safety and flexibility-no serious
adverse clinical reaction ever documented.
Chemically distinct among tranquilizers— not a pheno-
thiazine or a meprobamate.
Added frontiers of usefulness— antihistaminic; mildly
antiarrhythmic; does not stimulate gastric secretion.

...and for additional evidence

Supportive Clinical Observation

". . . Atarax appeared to reduce anxiety
and restlessness, improve sleep pat-
terns and make the child more amen-
able to the development of new pat-
terns of behavior. . . ." Freedman, A.
M.: Pediat. Clin. North America 5:573
(Aug.) 1958.

". . . seems to be the agent of choice
in patients suffering from removal dis-
orientation, confusion, conversion hys-
teria and other psychoneurotic condi-
tions occurring in old age." Smigel,
J. 0., et al.i J. Am. Geriatrics Soc.
7:61 (Jan.) 1959.

"All [asthmatic] patients reported
greater calmness and were able to
rest and sleep better ... and led a
more normal life.... In chronic and
acute urticaria, however, hydroxyzine
was effective as the sole medica-
ment." Santos, I. M., and Unger, I.:
Presented at 14th Annual Congress,
American College of Allergists, Atlan-
tic City, New Jersey, April 23-25, 1958.

". . . especially well-suited for ambula-
tory neurotics who must work, drive
a car, or operate machinery." Ayd, F.
J., Jr.: New York J. Med. 57:1742 (May
15) 1957.

New York 17, N.Y.

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Science for the World's Well-Being

Bayart, J.: Acta paediat. belg.
10:164, 1956. Ayd, F. J., Jr.: Cal-
ifornia Med. 87:75 (Aug.) 1957.
Nathan, L. A., and Andelman, M.
B : Illinois M. J. 112:171 (Oct.)
1957.

Seftel, E.: Am. Pract. & Digest
Treat. 8:1584 (Oct.) 1957. Negri,
F.: Minerva med. 48:607 (Feb.
21) 1957. Shalowitz, M.: Geri-
atrics 11:312 (July) 1956.

Eisenberg, B. C: J.A.M.A. 169:14
(Jan. 3) 1959. Coirault, R., et al.:
Presse m§d. 64:2239 (Dec. 26)
1956. Robinson, H. M.. Jr., et al.:
South. M. J. 50:1282 (Oct.) 1957.

^^

Garber, R. C, Jr.: J. Florida M.
A. 45:549 (Nov.) 1958. Menger,
H. C.: New York J. Med. 58:1684-
(May 15) 1958. Farah, L: Inter-
nal. Rec. Med. 169:379 (June)
1956.

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XXIV

NORTH CAROLINA MEDICAL JOURNAL

August, 1960

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North Carolina Medical Journaj

Owned and Published by
The Medical Society of the State of North Carolina

Volume 21

August, 1960

No. 8

Symposium on Acute Surgical Conditions

Of the Abdomen

Acute Abdominal Pain Associated
With Vascular Emergencies

Gordon M. Carver, Jr., M.D.
Durham

Acute abdominal pain of vascular origin
is still rare in comparison with that of ap-
pendicitis, peptic ulcer, and cholecystitis :
however, as our population age increases, ab-
dominal vascular emergencies will become
more frequent. Most of these vascular le-
sions are of arterial origin- and the earlier
the diagnosis is made and definitive treat-
ment instituted, the better the ultimate re-
sult.

Dissecting and Ruptured Abdominal
Aortic Aneurysms

The abdominal aneurysm may be relative-
ly asymptomatic until it begins to enlarge
as a result of dissection. Varying degrees
of severe pain in the abdomen or back then
develops and is thought to be due to disten-
tion and tearing of the muscular layers of
the aorta.

The diagnosis of dissecting abdominal
aortic aneurysm is usually quite simple.
Palpation of the abdomen reveals a pulsat-
ing mass which is often noted by the patient
himself. A lateral roentgenogram of the
lumbar spine may reveal calcification of the
aortic wall and determine the diameter of
the aneurysm. Angiography can be used to
establish the diagnosis but is usually not
necessary.

The clinical diagnosis of ruptured abdom-
inal aortic aneurysm is made on the basis of
. an acute onset of abdominal pain, with or
without shock, and the presence of a pulsat-
ing mass increasing rapidly in size. A flat

Presented before the Section on Surgery, Medical Society
Of the State of North Carolina. Raleigh, May 10, 1960.

plate of the abdomen may reveal an obliter-
ated psoas shadow as well as calcification in
the aneurysmal wall. Occasionally the blood
hematacrit and blood pressure may be main-
tained at a normal level for several hours or
even days after rupture of the aneurysm.
The point of rupture is most commonly seen
posteriorly, but it may be on the anterior
or lateral surface of the aorta.

The treatment mortality rate in elective
resections has diminished to such a point
that it is sound to recommend removal of
almost all abdominal aortic aneurysms on
diagnosis. One of the most compelling rea-
sons for resection is that more than 50 per
cent of patients with ruptured aneurysms,
although aware of the presence of the lesion,
have had no symptoms prior to the rupture.
In general the larger the aneurysm the
greater the probability of rupture. Justifi-
cation for the emphasis on elective surgery
in these cases is the evidence that it increases
life expectancy. DeBakey and Cooley(1) have
shown a postoperative survival rate of 82
per cent. Wright and others'-1, in their an-
alysis of the natural course of the disease,
found a steady decline in survival rates from
60 per cent at the end of one year to 16
per cent at the end of three years. There
is of course little or no argument regarding
the immediate indications for resection of
dissecting or ruptured aortic abdominal
aneurysms.

The surgical treatment consists of excis-
ing the aneurysm through a long xiphoid to
pubic incision, replacing the excised segment

314

NORTH CAROLINA MEDICAL JOURNAL

August, liiiiO

of aorta with a synthetic graft made of
teflon or dacron. Since most abdominal an-
eurysms arise distal to the renal arteries,
the aorta can be cross-clamped below these
vessels. Before the aorta is cross-clamped,
the distal site of anastomosis is determined
and these vessels are made ready for im-
mediate anastomosis. In most cases the in-
ferior mesenteric and lumbar arteries can be
ligated and cut prior to the actual cross-
clamping of either the iliac vessels or the
abdominal aorta itself. During resection
heparin is pumped into both lower extremi-
ties through a small polyethylene tube in-
serted into the distal arterial system by the
use of special pumping apparatus or with
syringe and three-way stop-cock. The an-
eurysm is then removed and the plastic graft
sutured in place as rapidly as possible.

The resection of a ruptured aneurysm dif-
fers in that the patient is often moribund
or in semi-shock. With adequate blood for
replacement, temporary proximal control of
the aorta is obtained by exerting pressure on
the upper abdominal aorta against the spine
in the lesser peritoneal sac and then placing
an occluding clamp on the aorta below the
renal arteries. The iliac vessels are cross-
clamped and the ruptured aneurysm is rap-
idly removed. The smaller bleeding vessels
are controlled and the graft is sewn in place.
In all cases bilateral lumbar sympathectomy
is performed prior to abdominal closure.

The mortality associated with resection
of aortic aneurysms is about 5 to 10 per
cent in the uncomplicated cases. In rup-
tured aneurysms it is still 25 to 50 per cent,
depending on the patient's general condi-
tion at the time of surgery.

Dissecting Thoracic Aortic Aneurysms

The predominant presenting symptom of
a dissecting thoracic aortic aneurysm may
be acute epigastric abdominal pain. Usual-
ly the pain is substernal in origin and may
simulate myocardial infarction ; however,
neurologic, renal and abdominal manifesta-
tions are frequent. These symptoms consist
of numbness, paraplegia, coma, hematuria,
and abdominal pain radiating to the legs or
back' and are usually related to the point of
dissection, with involvement of the corre-
sponding organ systems. The presence of
neurologic symptoms or signs in patients
with thoracic or abdominal pain may be a
clue to the early correct diagnosis of a dis-
secting thoracic aortic aneurysm.

The physical manifestations of a dissect-
ing aneurysm are not diagnostic. A precor-
dial apical or basal systolic murmur is pres-
ent in about 40 per cent of the cases. A di-
astolic murmur over the aortic area is con-
sidered to be of the greatest diagnostic sig-
nificance, but is present in only a small per-
centage of cases. This is simply a reflection
of the small number of individuals with in-
volvement of the ascending aorta or aortic
annulus. Brachial blood pressure differen-
tial, tracheal deviation, cervical venous dis-
tention, abdominal aneurysm, or obliteration
of peripheral pulses is rarely observed. Elec- i
trocardiograms reveal myocardial ischemia,
left ventricular strain, or disturbances of
rhythm in about 75 per cent of the patients. .

Roentgenograms of the chest usually re-
veal widening of the supracardiac mediasti-
num and radiolucence of the arch and de-
scending aorta in the region of the false
passage. Angiocardiograms taken with the
patient in an oblique position usually ac-
centuate the "double-barreled" appearance
of the lesion. This examination has been of
utmost value in determining the nature and
extent of the dissecting progess.

For the cardiovascular surgeon, it is im-
portant to divide these lesions into five cate-
gories, which then provide a guide to the
surgical approach and prognosis'3'.

Type I : The dissecting process extends from
the aortic annulus to a point well below
the diaphragm.

Treatment: Unless there is an area

where rupture is imminent, resection

with graft replacement is not indicated.

Creation of a re-entry passage is usually

the procedure of choice and may be done

with or without the aid of hypothermia

or atriofemoral by-pass perfusion.

Type II : The process is localized to the

ascending aorta and proximal transverse

arch.

Treatment: Excision of the lesion and
aortic graft replacement using extra-
corporeal pump oxygenator.
Type III : Distal transverse arch and de-
scending aorta.
Type IV: The dissecting process arises atj
the left subclavian artery and continues
well below the diaphragm.

Treatment: Excision of diseased tho-
racic segment and intraluminal closure
of distal segment prior to replacement
grafting.

August, 1960

SYMPOSIUM ON ACUTE CONDITIONS OF THE ABDOMEN

315

Type V : Lesion occurs in left subclavian ar-
tery with dissecting process remaining
localized in the descending aorta.

Treatment: Excision of the entire dis-
eased segment and replacement with a
graft.
The latter two types comprise about 90
per cent of the cases, and in each instance
hypothermia or some form of by-pass-shunt
is necessary to guard against spinal cord
ischemia.

In DeBakey's series of 60 cases the oper-
ative mortality of lesions occurring below
the subclavian was 18 per cent as compared
to an over-all mortality of 29 per cent131.
The most common type of lesion requires re-
section of the descending aorta, so as to in-
clude the site of origin of the dissection,
with graft replacement and obliteration of
the false lumen distally.

Aneurysms of Intestinal Vessels
Aneurysms of the major aortic branches
to the abdominal viscera are usually palpable
on physical examination, produce symptoms
of abdominal pain, and have the great ten-
dency to rupture common to all aneurysms.
Splenic aneurysms occur in the main trunk
of the vessel and are twice as common in
women, particularly pregnant women. Sple-
nomegaly is found in about 50 per cent of
the patients, and before rupture, symptoms
are mild, usually consisting only of epigas-
tric discomfort. Rupture into the lesser
peritoneal sac is followed by severe pain in
the back and left shoulder, associated with
shock or signs of peritoneal irritation. The
treatment of choice is resection of the artery
with the aneurysm, and splenectomy.

In aneurysms involving essential vessels
such as the hepatic and superior mesenteric
artery, resection with end-to-end anastomo-
sis of the vessel is performed when possible.
Small plastic grafts to the aorta can be used
effectively when primary anastomosis can-
not be performed.

Embolism and Thrombosis of the Superior
Mesenteric Artery

The superior mesenteric artery is the ves-
sel most often involved in infarction of the
abdominal viscera in both sudden embolic
occlusions and arteriosclerotic thrombosis.
This is probably related to the relative size
of the vessel, its anterior location, and the
angle it makes with the aorta at its exit.

Superior mesenteric arterial embolism is
usually associated with atrial fibrillation, a
recent myocardial infarction, or some other

disease which provides a source of emboli.
Sudden severe cramping periumbilical or
epigastric pain, frequently accompanied by
severe pain in the upper lumbar and lower
thoracic region, follows complete embolic oc-
clusion. The patient appears to be in early
shock and acutely ill, but the blood pressure
may be normal or elevated. The bowel re-
sponds to acute ischemia with spastic con-
tractions and loose mucoid stools. Within
two hours the acute pain may subside, leav-
ing the patient relatively asymptomatic.
Unless the condition is recognized, the error
may lead to a fatal postponement of opera-
tive treatment. The white blood cell count
rises early, and the peritoneal irritation and
abdominal tenderness make their appearance
as necrosis of the intestine, and secondary
bacterial invasion progresses. Signs of gen-
eralized peritonitis with abdominal disten-
tion, shock, and leukocytosis develop, to com-
plete the classic picture of massive intes-
tinal infarction. Paracentesis may yield a
characteristic dark, "prune-juice" tvpe of
fluid.

Early recognition of the entity and prompt
surgical removal of the embolus before ir-
reversible injury to the bowel has taken
place is the treatment of choice. Reports of
successful superior mesenteric embolectomy
have appeared with increasing frequency
since the urgency and value of the operation
was stressed by Klass,!1.

A typical history in a patient liable to
emboli, who begins to have acute abdominal
pain and tenderness, leukocytosis, and guiac-
positive stool- with absence of small-bowel
gas on x-ray, should immediately define the
need for emergency surgery. The reversibil-
ity of apparently severe degrees of ischemic
injury to the intestine after sudden occlusion
of the circulation has been striking. Dark
discoloration of the bowel does not neces-
sarily mean necrosis. Even if necrosis of
segments of the small bowel has advanced
to a point of no return, the combination of
embolectomy and bowel resection may allow
the preservation of a greater length of small
intestine.

Technique
When the abdomen is explored early, there
may appear to be very minor changes in the
circulation to the small bowel. A good pulse
in the main superior mesenteric artery must
be demonstrated. The ligament of Treitz is
identified and the mesocolon and lower bor-
der of the pancreas are reflected upward,

316

NORTH CAROLINA MEDICAL JOURNAL

August, 1960

exposing the superior mesenteric artery. A
heavy ligature is passed around the main
trunk of the artery to elevate it, and the first
jejunal and middle colic branches are ex-
posed. A longitudinal arteriotomy incision
is made and the clot is removed proximally
as far as its aortic origin. A bulldog arterial
clamp is applied after the vessel has been
cleared by a flush of aortic blood. The distal
thrombus is then removed by milking the
mesenteric vessels toward the arteriotomy
incision. Heparin is injected into the vessel
proximately and distally, and the incision
is closed with No. 6-0 black silk. Anticoag-
ulants are used in the postoperative period,
along with antibiotics and the usual surgical
measures that are employed after an explor-
atory laparotomy.

Arteriosclerotic Thrombosis of the Superior
Mesenteric Artery tuid Vein

Small-bowel infarction resulting from ar-
teriosclerotic thrombosis of the superior
mesenteric artery usually occurs by gradual
occlusion of this vessel, and will be preceded
by days or months of chronic gastrointes-
tinal symptoms. The most prominent symp-
tom is a cramping epigastric pain appearing
an hour or two after meals; weight loss is
due to failure to eat because of this pain.
Malabsorption may result in the fatty frothy
stools which characterize this disorder. In-
farction will be accompanied by a severe at-
tack of abdominal pain, but is apt to be less
dramatic in onset than are the symptoms
present with sudden embolic occlusion.

Treatment would ideally consist of recog-
nition in the prodromal phase, aortographic
demonstration of narrowing of the vessel,
and correction by thromboendarterectomy
or replacement grafting. The atheromatous
occlusion is almost always located in the
first centimeter and the adjacent aortic
wall'51. The vessel is cleared in a retrograde
fashion with a small curved clamp intro-
duced into the aortic lumen through the su-
perior mesenteric arteriotomy. Hemorrhage
from the vessel is readily controlled by digi-
tal pressure between extraction efforts. The
arteriotomy is closed, with attention given
to distal atheromas, tacking down or in-
cluding in the suture line the distal intima
to avoid subsequent dissection.

Thrombosis of the mesenteric vein is a
rare condition usually associated with intra-
abdominal infection. The diagnosis is diffi-
cult to make but is suggested by an episode
of subacute abdominal pain associated with

the passage of blood and mucus per rectum.
Specific surgical treatment depends on the
underlying cause and the location of the
vascular block.

Aortic Saddle Embolus

The classic evidence of a saddle embolus
of the aorta is sudden vascular insufficiency
of the lower extremities denoted by pain,
pallor, sensory and motor losses, and absent
pulses. There may also be pain in the abdo-
men, lower back, buttocks or perineal region,
or paresthesia depending upon the adequacy
of the collateral circulation. The embolus
usually arises from a thrombus in a rheu-
matic heart with mitral stenosis or insuffi-
ciency and atrial fibrillation, or from a mural
thromus secondary to myocardial infarction.

The prognosis for both life and limb is
poor without embolectomy. Reich"11 reported
that only 1 of 7 patients not operated on
survived. Burt and others'7' had a similar
experience with 16 patients, 8 of whom were
treated conservatively ; only two lived with-
out loss of legs. Four of 8 were operated on
successfully without loss of limbs. In general
the longer the delay prior to operative re-
moval of the embolus, the poorer the prog-
nosis, although emboli have been removed
after a delay of 24 hours'"'.

The operative approach may be transab-
dominal, retroperitoneal from the left side,
or by retrograde catheter suction of the
femoral artery. The transabdominal ap-
proach, employing a mid-line or paramedian
incision, is the most popular. After proximal
control of the aorta above the bifurcation
and the iliac vessels below the embolus, a
longitudinal incision is made in the aorta
overlying the clot. The embolus is removed
and blood is allowed to flush from both iliacs
to clear these vessels and check their retro-
grade flow, and then to clear the distal aorta.
The aortic incision is then closed with con-
tinuous No. 5-0 silk sutures. In draping the
patient prior to operation, it is important
to have both legs and feet in the operative
field so that peripheral pulses can be de-
termined immediately following removal of
the embolus by the operating surgeon. The
femoral or popliteal arteries can be explored,
if necessary, to clear them of small emboli
that may have broken off from the saddle
embolus.

The retroperitoneal approach from the
left sic1^ can be used in the presence of peri-
tonitis or extensive intraperitoneal adhe-

August, 1960

SYMPOSIUM ON ACUTE CONDITIONS OF THE ABDOMEN

3n

sions, but it has the disadvantage of poor
exposure of the right iliac artery and of the
operative site in general.

The retrograde femoral artery approach'1'
possesses the disadvantage of a blind, in-
direct method, yet may be performed suc-
cessfully with local anesthesia, thereby
avoiding a laparotomy in a seriously ill pa-
tient. In a recent study Willman and Han-
Ion110' recommend this technique not only for
those patients who are critically ill, but in
all patients. If the clot is not extracted suc-
cessfully, the patient can be put to sleep
and a transabdominal approach used. These
authors point out that unsuccessful attempts
at retrograde femoral removal by other op-
erators have been due in many instances to
the use of small catheters.

The largest thin-walled plastic catheter
that the vessel will accept is passed until the
catheter impinges on the embolus. A glass
T tube allows blood from collateral vessels
to flow through the vent until the catheter
tip reaches the embolus- then the suction line
is opened and the vent is closed. Aspirated
blood and thrombus are seen through the
glass T tube. The catheter is slowly with-
drawn, together with the firm embolus held
against the tip of the catheter by suction.
The same technique is used on the other
side and is repeated until there is a vig-
orous pulsital blood flow. This method was
used successfully on 4 patients, but cannot
be used on patients with previous obstruc-
tions or thrombosis in the iliac vessels.

In the postoperative management imme-
diate heparinization is not used routinely
after the abdominal approach if adequate
luminal clearance has been accomplished.
The complications associated with immedi-
ate heparinization in terms of wound bleed-
ing, hematoma, delayed wound healing, and
secondary infection appear to outweigh its
possible advantages. After the retrograde
femoral artery approach, however, immedi-
ate heparinization is utilized.

If the embolus arises from the left atrium
owing to mitral stenosis, mitral commissu-
rotomy and atrial appendectomy is prefer-
able to long-term anticoagulant therapy if
the patient can tolerate the procedure. One
advantage of the retrograde femoral ap-
proach is that after its completion under
local anesthesia it can sometimes be com-
bined immediately with mitral commissu-
rotomy. Belcher and Somerville'11' found a
less than 1 per cent incidence of postvalvu-

lotomy embolism in 430 collected cases, and
felt that commissurotomy was much prefer-
able to long-term anticoagulant therapy.

Summary

Acute abdominal pain of vascular origin is
most commonly due to the development of an
aneurysm, thrombosis, or embolus in the
arterial system within the abdomen. In gen-
eral the earlier the diagnosis, the better the
result of surgical treatment.

The diagnosis of dissecting or ruptured
abdominal aneurysms is not difficult, as the
pulsating mass can usually be felt. Resec-
tion of the aneurysm with graft replace-
ment is a lifesaving procedure when success-
ful.

Dissecting thoracic aortic aneurysms may
masquerade as an acute abdominal condition,
diagnosis can usually be made by x-ray
studies, and surgical treatment consists of
resection with graft replacement or construc-
tion of a re-entry passage.

Embolism or thrombosis of the superior
mesenteric artery may be treated by em-
bolectomy or thromboendarterectomy if rec-
ognized early, thus avoiding infarction of
the small bowel.

Diagnosis of aortic saddle embolus in its
early stages and the use of modern vascular
surgical techniques have improved the sal-
vage rate considerably in the past 10 years.

References

1. DeBakey. M. E., Cooley. D. A., and Creech. O.. Jr.:
Aneurysm of Aorta Treated by Resection: Analysis of
313 cases. J. A. M. A. 163:1439-1443 (April 20) 1957.

2. Wright. I. S., Urdaneta, E., and Wright, B. : Re-Open-
ing the Case of the Abdominal Aortic Aneurysm. Cir-
culation 13: 754-768 (May) 1956.

3. DeBakey, M. E„ and Henley, W. S. : Dissecting Ane-
urysm of the Aorta. Internat. Forum, 8: 116-118, 1960.

4. Klass, A. A.: Embolectomy in Acute Mesenteric Occlu-
sion, Ann. Surg. 134: 913-917 (Nov. I 1951.

5. Derrick, J. R.. and Logan, W. D.: Mesenteric Arterial
Insufficiency, Surgery 44: 823-827 (Nov.) 1958.

6. Reich, N. E.: Occlusions of the Abdominal Aorta: A
Study of 16 cases of Saddle Embolus and Thrombosis.
Ann. Int. Med. 19: 36-59 (July) 1943.

7. Burt, C. C. Learmonth, J., and Richards, R. L.: On
Occlusion of the Abdominal Aorta. Edinburgh M. J.
59: 65-93 (Feb.) 1952.

8. Ewing. M. R. : Aortic Embolectomy. Brit. J. Surg. 38:
44-51 (July) 1950.

9. Randin, I. S.. and Wood. F. C. : The Successful Re-
moval of a Saddle Embolus of the Aorta. Eleven Days
After Acute Coronary Occlusion, Ann. Surg. 114:834-839
I Nov.) 1941.

10. Willman. V. L.. and Hanlon, R. : Safer Operation in
Aortic Saddle Embolism, Four Consecutive Successful
Embolectomies via the Femoral Arteries Under Local
Anesthesia, Ann. Surg. 150:568-574 (Oct.) 1959.

11. Belcher, J. R.. and Somerville, W.: Systemic Embolism
and Left Auricular Thrombosis in Relation to Mitral
Valvolotomy. Brit. M. J. 2: 1000-1003 (Oct. 22) 1955.

318

NORTH CAROLINA MEDICAL JOURNAL

August. 19(30

Diagnosis and Treatment of
Intussusception in Infants and Children

Louis Shaffner, M.D.*
Winston-Salem

Intussusception is the invagination or
telescoping of a portion of bowel into the
bowel distal to it. It occurs usually in the
region of the terminal ileum, being of the
ileo-colic type; but colo-colic, ileo-ileal, and
the treacherous and complicated ileo-ileo-
colic types are occasionally encountered.

The mesenteric blood vessels are pulled in
between the layers of bowel and subsequently
obstructed by tension and pressure. The re-
sult is a strangulating process of the intus-
suscepted portion and a mechanical obstruc-
tion of the innermost lumen from the result-
ant edema of the bowel wall.

If left untreated, 95 per cent of the pa-
tients will die. The few who recover do so
by a spontaneous reduction or a sloughing
of the gangrenous portion into the distal
bowel, with relief of the obstruction.

Intussusception is an acute painful ab-
dominal condition and a discussion of it fits
in well with the other papers presented on
this program. It is, however, unique among
the subjects covered in that it occurs prin-
cipally in infants and children. As such,
the discussion of it can serve as a reminder
of the value of modifying for infants and
children the procedure of physical examina-
tion usually followed in adults.

Intussusception furthermore is a condi-
tion about which there is no complete agree-
ment as to the best form of treatment.
Ravitch"1 has emphasized again the value of
a barium enema under hydrostatic pressure
as the initial therapy prior to any operative
approach.

Our experiences with 22 cases at the
North Carolina Baptist Hospital will be
summarized.

Diagnosis

Some 80 to 90 per cent of reported cases
of intussusception occurred in children un-
der 2 years of age, the majority ranging
between 3 and 11 months. The patients are,
therefore, old enough to complain but too
young to describe their complaints.

The mother usually states that the baby
had been entirelv well until suddenly he be-

*From the Department of Surgery. Bowman Gray School
of Medicine. Winston-Salem. N. C.

gan to have severe attacks of "colic," char-
acterized by an agonizing cry of pain, pallor,
a drawing up of the legs upon the abdomen,
and vomiting. This might last 30 seconds to
a minute, followed by apparent relief for
minutes to hours, only to be repeated again
and again until the baby looked limp, refused
all feedings, and perhaps became distended.
A normal bowel movement might occur, and
after several hours there may be some blood,
bright red or the dark, so-called "currant
jelly" type, mixed with the stools.

It should be emphasized that blood in the
stools is not an early manifestation, for when
it does occur it is an indication of consider-
able venous obstruction in the involved bow-
el, causing ulceration and bleeding of the
mucosa. The symptoms are suggestive
enough of intussusception before blood ap-
pears, yet experience has shown that the
appearance of blood does not mean that the
bowel is gangrenous and that resection will
be mandatory.

The important positive sign during exam-
ination of the abdomen is the presence of an
elongated or sausage-shaped, only slightly
tender, mass anywhere along the course of
the colon. This may vary in size with peris-
taltic activity, or be constant in size and
definitely tender, indicating more edema and
a more severe impairment of the blood sup-
ply. A relative emptiness of the right lower
quadrant, known as Dance's sign, is difficult
to interpret, but if present suggests that an
elusive mass may be hiding either under the
liver edge or under the left rib cage at the
splenic flexure.

Peristalsis will be that of small bowel colic,
and when it is heard, the child will at the
same time tighten his abdominal muscles
and cry until the episode is passed.

Method of Examination
Examination of the "acute abdomen" in
an inarticulate, uncooperative, frightened,
crying, irritable, sick baby can be a difficult
and unrevealing procedure unless the rou-
tine is modified from that used in adults.

A general inspection of the baby will re-
veal by his color, attitude, and activity
whether he is acutely ill and whether his

August, 1960

SYMPOSIUM ON ACUTE CONDITIONS OF THE ABDOMEN

319

abdomen is distended or a hernia protrudes.
If the baby is lying quietly in his mother's
arms when first seen, then is the opportune
time to place the stethoscope gently on the
abdomen to determine peristalsis and, if he
remains quiet, to listen to the anterior chest.

Gentle and light palpation with a warm
hand comes next. If there is no distention,
it is usually easy to determine the presence
of muscle spasm or a palpable mass. It is
gratifying to find that if this initial palpation
is gentle, light, and slow, any response from
the baby such as a whimper, a squirm, a
facial wince, or a sudden tightening of the
musculature is a reliable sign of tenderness
beneath the palpating hand. These actions
can speak as loudly as words to say, "That
hurts." If at the first such sign the examiner
removes his hand, the baby will usually be-
come quiet again. More thorough palpation
of the non-tender areas can then be repeated,
and finally the tender area confirmed.

Percussion of the abdomen can be as much
a test for rebound tenderness as for tympany
or shifting dullness. If done very gently, it
too can localize the tender area by the same
responses.

But what if the baby is crying and tossing
when first seen, and, as often happens, has
been taken from his mother, disrobed, held
naked on a cold table, and a thermometer
thrust up his rectum? Or what if one gags
his throat, pokes his ears, twists his neck,
turns him over, and thumps his chest be-
fore examining his abdomen?

There is only one answer. The baby must
be quieted down and relaxed before the ab-
dominal examination can be satisfactory.
Maybe a few minutes in his mother's arms
will do it. If he isn't vomiting, maybe a
bottle or a sugar nipple will do it. But it
may also take a pentobarbital suppository
or a subcutaneous injection of Demerol
(1.0 mg. per pound) 20 or 30 minutes to
do it. If such sedation seems necessary, it
should be used for the good of everybody
concerned.

Certainly a complete examination should
be done, but in an order and a manner that
allows a thorough abdominal examination in
a quiet, relaxed child. The final rectal exam-
ination is done not only to check for blood
but also for tender masses. At times the
leading point of an intussusception, like a
small cervix, can be felt within the rectal
ampulla.

Differential Diagnosis

There are no other conditions that present
the findings of a typical intussusception.
But sometimes the signs of small bowel ob-
struction are dominant, and the distention
prevents palpation of the intussuscepted
mass. An ulcerated Meckel's diverticulum
alone or a polyp can cause bloody stools, and
appendicitis and all forms of acute enteritis
must be thought of.

When the diagnosis of intussusception is
suspected but no abdominal mass is palpable,
a barium enema for diagnosis alone will
settle the issue and at times will cure the
disease. The retrograde flow of barium will
slow at the leading point of the intussuscep-
tion, then outline it with the "coiled spring"
sign, and sometimes reduce it in seconds.

Treatment

Basically the treatment of intussusception
is that of relieving an intestinal obstruction
at the point of the obstruction. Supportive
measures to correct dehydration and relieve
intestinal distention should, of course, be
started as soon as the diagnosis is made.

The only controversy seems to be whether
an initial trial at reduction by a barium en-
ema under hydrostatic pressure is safe and
effective. Even the opponents of such a trial'2'
admit they have seen barium enemas given
primarily for diagnosis cause ready reduc-
tions and obviate an operation. These have
occurred principally in patients seen within
24 hours of the onset of symptoms.

Ravitch(1341 in urging the routine trial
of this method, presents convincing evidence
from Scandinavian and Australian clinics
and from his own experience that it is ef-
fective in 3 out of 4 cases and is attended
by much less morbidity and mortality than
operative treatment alone. He reports no
deaths in 65 patients so treated, and in cases
of successful reduction by the enema the
hospital stay was only one-third as long as
those requiring operation.

He refutes the objections of others by
pointing out that with his method irreduc-
ible bowel will not rupture nor a gangrenous
one be reduced. There is less trauma to the
bowel itself than by manual reduction. There
will be a correctable cause, such as a polyp
or Meckel's diverticulum, in only 5 per cent
of the patients, and none of these require
immediate removal. If complete reduction
is not successfully demonstrated, there is no
delay ; surgical exploration is performed im-
mediately through a McBurney incision.

320

NORTH CAROLINA MEDICAL JOURNAL

August, 1900

Table 1

Symptoms and Signs

22 Cases

No. PerCent

Intermittent abdominal pain 22 100

Vomiting 22 100

Bloody stools 16 73

Palpable abdominal mass 14 64

Abdominal distention-obstruetion 4 18

He finally stresses the point that this is a
hospital surgical procedure and can be sim-
ply compared to an initial attempt at a closed
reduction of a fracture. If not successful,
open reduction may be necessary. Physicians
will refer suspected cases sooner, and par-
ents will readily agree to early hospitaliza-
tion if by so doing there is an excellent
chance of cure without an operation.

Technique

Ravitch's method in the use of barium
under fluoroscopic control may be summar-
ized as follows: (1) Insert a 45 cc. Foley
bag catheter in rectum; (2) maintain a 3-
foot elevation of barium reservoir; (3) per-
sist with constant pressure if progress made ;
(4) proceed with surgical exploration if
ileum is not well filled; and (5) instill pow-
dered charcoal into the stomach if reduction
is apparent.

His criteria of reduction are: (1) free
flow of barium into small bowel; (2) return
of feces or flatus with barium; (3) disap-
pearance of mass; (4) clinical improvement,
and (5) recovery in stool of charcoal.

Summary of Cases

Twenty-two cases of intussusception in the
pediatric age group have been seen at the
North Carolina Baptist Hospital from 1946
through 1959. This represents 20 patients,
2 having been admitted twice for a recur-
rence of the condition. There were 14 males
and 6 females. Thirteen were between the
ages of 3 months and 2 years, 6 from 2 to 4
years of age, and 3 from 5 to 10 years of
age.

The predominant signs and symptoms are
noted in table 1. The duration of symptoms
from onset to initiation of treatment varied
from four hours to four days. The correct
diagnosis was suspected clinically in all pa-
tients except the 4 showing predominantly
the signs of small bowel obstruction.

Our only death was in one of these, a 3
year old girl who was admitted with a four
hour history of intermittent abdominal pain
and vomiting, preceded the day before by
passage of a bloody stool without pain. The
abdominal examination revealed no masses,

Table 2
Treatment
(22 Cases)
Nonoperative reduction

Spontaneous

Plain enema

Barium enema

3
8

4*

15

Total

Operative treatment

Exploratory (obstruction already reduced) ....

Manual reduction

Resection or exteriorization

Total

* 1 death: operative mortality 1%

or tenderness, but peristaltic rushes were
heard that coincided with apparent pain. No
blood was found in the stools. A plain roent-
genogram of the abdomen was not diagnos-
tic. After a 24-hour delay during which
symptoms progressed, a diagnostic barium
enema revealed an intussusception in the
cecum. At operation an ileo-colic mass was
reduced, and a gangreous portion of ileum
containing an ectopic pancreatic nodule was
resected. Hyperpyrexia and convulsions de-
veloped during the procedure and the patient
died two hours later. An autopsy was not
obtained.

Only 15 of the cases required operation,
table 2. The clinical diagnosis in the 4 that
were reduced spontaneously or by plain en-
emas was certain enough to be included in
the group. Diagnosis of the other 3 was con-
firmed at the time of reduction by barium
enema. The one death gives an operative
mortality of 7 per cent and an over-all mor-
tality of 4.5 per cent.

Table 3

Etiology

15 Operative Cases

Antecedent diarrhea

Hyperplastic Peyer's patch

Meckel's diverticulum

Ectopic pancreas in ileum

Papilloma of cecum

Mobile cecum

Prominent ileo-cecal valve

Recent bowel surgery

Idiopathic

.._ 2

Probable etiologic factors in the 15 oper-
ative cases are listed in table 3. The hyper-
plastic Peyer's patches seemed to be the lead-
ing points in 2 cases, and in each the appear-
ance of the mesenteric nodes was compatible
with a coincident diagnosis of mesenteric
adenitis.

Barium enema examinations were done in
13 patients. The other 9 included those who
improved spontaneously or after a plain
enema and those who were considered can-
didates for exploration for severe obstruc-

August. 1960

SYMPOSIUM ON ACUTE CONDITIONS OF THE ABDOMEN

321

Table 4
Barium Enema in Intussusception
Attempted reduction _ 11

Successful — no surgery 3 — 21'',

Successful — proved at surgery 2

Unsuccessful — operative treatment 6

tion. In only 11 was any attempt made to
reduce the intussusception by hydrostatic
pressure, table 4. This was successful in
only 3 patients (27 per cent), symptoms
having been present 12 hours in 2 and 4
days in the third. In 2 additional cases op-
eration disclosed complete reduction, even
though the terminal ileum had not filled with
barium. Symptoms had been present less
than 12 hours in each of these cases.

Comment

The two recurrent cases are of interest.
In one, the first episode occurred at 13
months of age, and after an unsuccessful
attempt at reduction by barium enema an
ileo-ileo-colic type of intussusception was re-
duced at operation. When similar symptoms
recurred at the age of 3 years, exploration
was done without a preliminary enema and
an ileo-ileal type was found to have been re-
duced spontaneously.

In the other the first episode occurred at
16 months of age, barium enema was unsuc-
cessful, and an ileo-colic type of intussuscep-
tion was easily reduced at operation. The
intussusception recurred at the age of 2i/o
years, was easily reduced by a barium en-
ema, and the patient was discharged 48 hours
later. Three months later she had a third
episode of intermittent pain, vomiting, and
passage of a grossly bloody stool during a
12-hour period. She then improved spon-
taneously, and four hours later examination
of the abdomen was normal and barium en-
ema showed no intussusception. A barium
study of the small bowel was subsequently
normal. When seen recently at age 14, she
had had no further trouble. Undoubtedly,
the third attack was due to another intus-
susception which was reduced spontaneously.

These 2 cases illustrate that a past history
of an intussusception requiring operative
reduction does not necessarily imply that a
recurrent episode will demand another op-
eration. A barium enema might prove a
spontaneous reduction or effect a therapeu-
tic one.

This series of 22 cases is admittedly a
■ small number from which to draw conclu-
sions. Nevertheless, we certainly have had
; no complications from trying reduction by

barium enema, and the successful patients
have gone home in less than three days. In
retrospect several of our operative cases,
including the fatality, might have been di-
agnosed and treated sooner had a barium
enema been done at the first suspicion of
intussusception.

Our radiologists have been reluctant to
prolong or persist at any attempt at reduc-
tion as long as Ravitch does. And our sur-
geons have withheld exploration only when
the evidence of complete reduction was quite
convincing. Yet with this conservative ap-
proach we have had some success and have
done no harm. As we gain experience our
percentage of reductions with barium enema
may rise. The more we encourage early di-
agnosis by requesting a barium enema in all
suspected cases, the better chance we have
to treat these babies safely, simply, and
easily.

Summary

Intussusception should be suspected in
any infant with a history suggestive of the
sudden onset of small bowel obstruction.

A satisfactory examination of the "acute
abdomen" in an infant requires a modifica-
tion of the order and manner of examination
usually used in adults. The infant must be
quiet and relaxed.

Ravitch's method of an attempt at reduc-
tion by barium enema under hydrostatic
pressure has led to earlier diagnosis, suc-
cessful treatment in 3 out of 4 cases, and a
reduction in over-all morbidity.

Twenty-two cases have been analyzed.
Three of 11 intussusception were reduced
by barium enema without operation. Out of
15 operative cases there was one death, that
attributable to a delay in diagnosis which
could have been reached sooner if a barium
enema had been done when first indicated.

A barium enema in all suspected cases can
lead not only to an earlier diagnosis, but also
to an easier and simpler cure.

References

1. Ravitch, M. M. : Non-Operative Treatment of Intus-
susception; Hydrostatic Pressure Reduction by Barium-
Enema Under Fluoroscopic Control; Current Surgical
Management, Philadelphia, W. B. Saunders Co., 1957.
pp. 358-367.

2. (a) Fox, P. P.: Intussusception: Surgical Treatment.
S. Clin. North America 36: 1501-1509 (Dec.) 1956. (b)
Gross, R. E. : The Surgery of Infancy and Childhood,
Philadelphia, W. B. Saunders Co., 1933, pp. 281-300.

322

NORTH CAROLINA MEDICAL JOURNAL

August, I960

(c) Izant. R. J., Jr.. and Clatworthy. H. W.. Jr.: Sur-
gical Treatment of Intussusception: Current Surgical
Management. Philadelphia. W. B. Saunders Co.. 1957.
pp. 349-357. (d) Swenson. Orvar: Pediatric Surgery. New
York. Appleton-Century-Crofts, Inc.. 1958, pp. 328-340.
If) Potts. W. J.: The Surgeon and the Child. Phila-
delphia, W. B. Saunders Co., 1959, pp. 167-170.

:i. Ravitch, M. M., and McCune. R. M., Jr.: Reduction of
Intussusception by Barium Enema, Clinicpl and Ex-
perimental Study, Ann. Sure. 128:904-917 'Nov.) 1948.

4. Ravitch. M. M.: Reduction of Intussusception by Ba-
rium Enema, Surg. Gyn. Obst. 99:431-436 (Oct.) 1954.

The Diagnosis and Treatment of Acute Diverticular

Disease of the Colon

E. Jackson Dunning, M.D., F.A.C.S.
Charlotte

Diverticula of the colon are of two types :
congenital and acquired. They are separate
entities. The congenital diverticulum is a
true diverticulum and therefore contains all
the layers of the normal colon wall. This
type is rare, is usually solitary, appears most
frequently in the cecum, and seldom causes
symptoms unless acutely inflamed'1'. The
acquired variety (fig. 1), being by-products
of degeneration, are false diverticula ; they
are usually multiple and usually appear after
40 years of age, when the incidence in-
creases'-1. These diverticula are found most
often in the sigmoid colon and occur with
diminishing frequency from the left side of
the colon to the right side(:,). Predisposing
factors — for example, narrowing, spasm,
stasis, and increased intraluminal pressure
— are most pronounced in the sigmoid'4'.
This probably also accounts for the fact that
the inflammation of the diverticula usually
occurs only in the sigmoid and rarely in any
other segment of the colon'3"- 5'.

It has been said that diverticulosis coli
will be found in 5 to 10 per cent of people
who undergo a barium enema, and that
about 15 per cent, or 8 patients in 1,000, will
probably have some type of diverticulitis'3"'6'.
Undoubtedly the incidence of diverticular
disease and its complications will steadily
increase with our lengthening life span27'.
The more diverticula present in the colon,
the greater the chance of developing some
form of diverticulitis, but the age of onset of
diverticulosis does not influence the likeli-
hood of the onset of inflammation'*1.

Classification

Diverticular disease of the colon, and of
the sigmoid colon in particular, can give rise
to a number of acute processes which should
be considered :

1. Acute sigmoiditis'1".

This process may progress to frank
peritonitis, or obstruction, or pericolic
abscess formation.

2. Perforation of a diverticulum with or
without inflammation'1'".

3. Hemorrhage.

Bleeding may be acute and massive
with or without diverticulitis'111.

4. Acute diverticulitis with small bowel
obstruction.

5. Acute diverticulitis with fistula or
sinus formation.

6. Acute diverticulitis with cancer or con-
fused with cancer.

Obviously, the complications of diverticu-
losis coli are rarely so distinctly set apart
clinically; rather, the involvement or changes
in any given case may encompass one or all
of these pathological processes. Also it
should be stated that any of these clinical
pictures may appear without the slightest
suggestion of prior colon disease'11'".

Diagnosis

1. Acute sigmoiditis: The typical picture
of acute diverticulities or acute sigmoiditis
is that of a middle-aged, obese, constipated,
sedentary individual with pain in the left
lower quadrant of the abdomen'12' or left
iliac fossa (3b). A history of diverticulitis is
helpful, for 45 per cent of patients who have
one attack of diverticulitis will have another
attack'131. The pain and signs may be right-
sided if the redundant and inflamed colon
lies to that side. Also, diarrhea may be a
complaint or diarrhea alternating with con-
stipation.

Examination reveals the objective evi-
dence of infection — for example, the eleva-
tion of temperature, pulse rate, and white
blood count plus the signs of intraperitoneal
inflammation : abdominal distention, dimin-
ished peristaltic activity, abdominal tender-

August, 1960

SYMPOSIUM ON ACUTE CONDITIONS OF THE ABDOMEN

323

Fig. 1. Photomicrograph (x 1) of an acquired di-
verticulum of colon.

ness, rebound tenderness in the lower part
of the abdomen, muscle-guarding over the
sigmoid, and possibly a palpable sausage-
shaped mass. The patient's age — that is,
whether child or adult — and the origin of
the pain further help to distinguish this
process from appendicitis. In appendicitis
the pain characteristically begins above the
umbilicus and is likely to be associated with
nausea and vomiting, while the pain of sig-
moiditis originates below the umbilicus and
is less likely to be accompanied by nausea
and vomiting1'1". In diverticulitis the pain
may come and go over a period of weeks.
Salpingitis, tubo-ovarian abscess, ovarian
tumors, strangulated hernia, sigmoid volvu-
lus, and mesenteric thrombosis are diag-
noses which should be considered. A small,
carefully administered barium enema is the
best single diagnostic test'12'.

2. Perforation: Free perforation of a di-
verticulum of the colon is much more com-
mon than generally realized and usually
happens with little or no warning171". The
pain produced is severe and knife-like, and
may radiate to the back, hip, thigh, anus,
or genitalia'12'. Typically it is associated
with nausea, vomiting, and distention, with
the development of severe intraperitoneal
reaction such as that seen in the rupture of
any other hollow viscus. An upright chest
film will often show the subphrenic air (fig.
2) and narrow the diagnosis to rupture of
peptic ulcer or diverticulum. A good history
of any prior difficulty, together with the
point of major abdominal tenderness, should
■ aid in making the proper diagnosis.

3. Hemorrhage: Bleeding in diverticulosis
coli has been reported in from 4 to 28 per

Fig. 2. Upright roentgenogram of the chest show-
ing subphrenic air accumulation from perforation
of colon diverticulum.

cent of the patients, but the number exhibit-
ing massive hemorrhage is much smaller'11"1.
Bleeding from other benign colon and ano-
rectal lesions must be ruled out by barium
enema and sigmoidoscopic examination, but
it is especially important to rule out malig-
nancy as a source of hemorrhage. Earley(Ub)
has compiled from his experience and others
the following criteria for concluding that
the bleeding arises from diverticular dis-
ease:

1. Passage by rectum of bright or dark
blood ;

2. Sigmoidoscopy, barium enema, and air
contrast studies showing diverticular
disease and excluding other potentially
bleeding lesions ;

3. Stomach and small intestine normal to
x-ray visualization ;

4. Normal coagulability of blood.

4. Acute diverticulitis with small bowel
obstruction :

This complication has not been adequately
stressed in discussions of diverticulitis' 71>- 9|.
The clinical picture produced is one of acute
sigmoiditis together with the picture of small
bowel obstruction, — namely, nausea, vomit-
ing, cramp-like pains, abdominal distention,
rushes of peristalsis, and fluid-air levels in
dilated small bowel on erect x-ray films of
the abdomen"". This problem must be dis-
tinguished from the myriad of causes of
small bowel obstruction, especially those
with associated intraperitoneal infection.

5. Acute diverticulitis with fistula or sinus
formation: The formation of a vesico-colic
fistula (fig. 3) may be heralded by symp-
toms of cystitis'2- !1>, and even after the rup-

:m

NORTH CAROLINA MEDICAL JOURNAL

August, 1960

Fig. 3. Barium enema roentgenogram revealing
extensive diverticulosis of sigmoid colon and air
in (he bladder as a result of a vesicolonic fistula.

ture into the bladder has taken place the
patient's symptoms are largely directed to
the genitourinary tract14'. Cripps'151 has
stated that inflammatory lesions more fre-
quently cause sigmoidovesical fistulas than
do malignant lesions. Fistulas between the
colon and affixed small bowel may occur, with
resultant abdominal cramps and diarrhea,
or the inflammatory process may burrow to
the skin to form a colocutaneous sinus.

6. Acute diverticulitis and cancer: Al-
though the simultaneous occurrence of these
two processes is rare'"'7"1, the problem of dif-
ferentiation arises often. The problem has
been touched on under "Hemorrhage," for
here the suspicion of malignancy is great.
The distinction may also be difficult in the
other classes — for example, acute sigmoid-
itis with obstruction, or even perforation.
X-ray examination is the best method of es-
tablishing the true diagnosis, for there are
some very definite differences in the appear-
ance of malignancy as contrasted with that
of the complications of diverticulosis14'.
Even so, in a high percentage of cases the
diagnosis is not known until operation or
even until a microscopic report is rendered
.71.. i::, por this reason the colon specimen
should be opened in the operating theater
to be certain that a malignancy has not been
overlooked and inadequately resected.

Treatment

Treatment in any case of acute diverticu-
lar disease must be sensibly individualized,
because, as stated earlier, any one case may
present some aspect of any or all of our arbi-
trary classification.

1. Acute sigmoiditis without sufficient re-
action to produce either paralytic ileus or
progression or obstruction can be treated
by a nonoperative regimen such as bed rest,
antispasmodics, oral liquids, stool softeners,
and intestinal antiseptics. The preferred
antibiotics range from sulfasuxidine to a
combination of penicillin-streptomycin. If
the condition progresses under this program,
therapy must be stepped up to nothing in-
gested by mouth, nasogastric suction, paren-
teral fluids, parenteral antispasmodics, and
parenteral antibiotics. If the inflammatory
process is checked, prophylactic resection
should be seriously considered. If on the
other hand the process is not checked and
further complications loom, a loop colostomy
should be carried out in the right transverse
colon with elective sigmoid resection in four
to eight weeks.

Whenever a case of acute diverticular dis-
ease progresses to the point that a colostomy
is necessary, then the involved bowel should
be resected before the colostomy is closed15"'
iia, i3, if.. At resection it is not necessary to
remove all of the colon containing diverti-
cula, but it is essential that the entire sig-
moid be removed lest residual sigmoid di-
verticula lead to recurrent diverticulitis'171.

One other operative approach to acute sig-
moiditis needs to be mentioned : the acute
sigmoiditis found unexpectedly at operation.
In this situation several methods of handling
diseased bowel are available: an exteriori-
zation procedure, formation of a proximal
colostomy, or a delayed one-stage resection
after preparation.

2. Perforation of a diverticulum of the
colon is best treated by a proximal colostomy
and drainage of the pelvis. No effort should
be made to track down the exact spot of
leakage with an attempt to oversew the
opening in inflamed and necrotic tissues. Ex-
teriorization of the diseased colon segment
has been carried out, and even a nonopera-
tive technique has been used, but proximal
colostomy and drainage is safest. Again,
once the diverticular disease has progressed
to the point of rupture, resection should be
the ultimate goal.

August, 19G0

SYMPOSIUM ON ACUTE CONDITIONS OF THE ABDOMEN

325

3. Hemorrhage from diverticular disease
with or without inflammation will often sub-
side on nonoperative measures11"'. This then
allows for an elective resection on a proper-
ly prepared bowel. A nonoperative measure
which may produce a dramatic cessation of
bleeding is the barium enemallS). Presum-
ably the barium enters the offending diverti-
cula and produces a tamponade effect. The
minority of patients who do not stop bleed-
ing on a nonoperative approach will, of
course, require an emergency colon resec-
tion. These are usually older patients(Ub).

4. Acute diverticulitis with small boivel
obstruction must be recognized and not
treated by proximal colostomy alone for ob-
vious reasons'91. Intensive nonoperative
treatment may be condoned for 24 or even
48 hours if the obstruction seems to be par-
tial and possibly due to exudation and edema.
If there is no relief of the obstruction or if
the obstruction recurs, it is necessary to
form a colostomy and free the small bowel
obstruction.

5. Acute diverticulitis with fistula or sinus
formation should be treated by a proximal
colostomy and eventual resection of the dis-
eased colon. Simple dissection of a colo-cut-
aneous sinus or a colon fistula with closure
invites a recurrence. Also, to close the prox-
imal colostomy without resecting the dis-
eased colon in cases of fistula and sinus in-
vites recurrence113'.

6. Acute diverticiditis and cancer produce
a much greater sense of urgency to proceed
to wide resection of the involved bowel. Ear-
ly proximal colostomy may diminish the in-
flammation more quickly than a nonopera-
tive approach, and resection may be carried
out within two to three weeks, leaving the
proximal colostomy as a protection against
suture line leakage.

Summary
Acute effects or complications of diverti-
culosis coli have been arbitrarily divided
into : acute sigmoiditis, perforation, hemor-
rhage, acute diverticulitis with small bowel
obstruction, acute diverticulitis with sinus or
fistula formation, and acute diverticulitis
with associated malignancy. Some sugges-
tions have been made as to the methods of
diagnosing and treating these complications.
The nearest common denominator seems to
be that the more frequently we resect the
colon in symptomatic, progressive diverticu-
lar disease, the less often these complications
will have to be treated.

References

1. (a) Degenshein, G. A.: Diverticulitis of the Right Colon.
A. M. A. Arch. Surg. 76: 564-568 (April) 1958. (b) Mann,
R. W.: Solitary Cecal Diverticulitis. A. M. A. Arch.
Surg. 76: 527-529 (April) 1958. (c) Zinninger. M. M. :
Dlvertlculosis and Diverticulitis of the Colon, Am.
Surgeon 22: 683-695 (Aug.) 1956.

2. Littlefleld, J. B.: Surgical Complications of Diverti-
culitis and Dlvertlculosis of the Sigmoid Colon, Am.
Surgeon 23: 272-277 (March) 1957.

3. (a) Smithwick, R. H.: Experiences with the Surgical
Management of Diverticulitis of the Sigmoid. Ann.
Surg. 115: 969-985 (June) 1942. (b) Spriggs, E. I., and
Marxer, O. A.: Multiple Diverticula of the Colon, Lancet
1: 1067-1074 (May 21) 1927.

4. Mayo, C. W., and Blunt, C. P.: The Surgical Manage-
ment of the Complications of Diverticulitis of the
Large Intestine: Analysis of 202 Cases, S. Clin. North
America 30: 1005-1012 (Aug.) 1950.

5. (a) Boyden, A. M.: The Surgical Treatment of Diverti-
culitis of the Colon, Ann. Surg. 132: 94-109 (July)
1950. (b) Jones, T. E.: Diverticulitis and Diverticu-
losis of the Colon, S. Clin. North America 19: 1105-
1117 (Oct.) 1939.

6. Jones, T. E. : Surgical Treatment of Diverticulitis, Ohio
State M. J. 34: 1225-1223 (Nov.) 1938.

7. (a) McGowan, F. J., and Wolff, W. I.: Diverticulitis
of the Sigmoid Colon, Gastroenterology 21: 119-132
(May) 1952. (b) McMillan, F. L., and Jamieson, R. W.:
Trends in the Surgical Treatment of Diverticulitis of
the Colon, S. Clin. North America 35: 153-173 (Feb.)
1955.

8. Horner, J. L.: Natural History of Diverticulosis of the
Colon, Am. J. Dig. Dis. 3: 343-350 (May) 1958.

9. Bodon, G. R., and Lapuz, B.: Acute Small Bowel Ob-
struction with Sigmoid Diverticulitis and Its Manage-
ment, Surgery 44: 631-635 (Oct.) 1958.

10. Fitts, W. T., Jr., and Anderson, L. D. : Spontaneous
Perforation of Sigmoid Colon in Presence of Diverticu-
losis; Report of 2 Cases Without Evidence of Inflamed
Diverticula, J. A. M. A. 152: 1427-1428 (Aug. 8) 1953.

11. (a) Bacon, H. E., and Valiente, M. A.: Surgical Man-
agement of Diverticulitis, Am. J. Surg. 91: 178-183
(Feb.) 1956. (b) Earley, C. M., Jr.: The Management
of Massive Hemorrhage from Diverticular Disease of
the Colon, Surg. Gynec. & Obst. 108: 49-60 (Jan.) 1959.

12. Morton, J. J., Jr.: Diverticulitis of the Colon, Ann.
Surg. 124: 725-745 (Oct.) 1946.

13. Colcock, B. P.: Surgical Management of Complicated
Diverticulitis, New England J. Med. 259: 570-573 (Sept.
IS) 1958.

14. (a) Lynn, T. E., Farrell. J. I., and Grier, J. P.: Sig-
moidovesical Fistula Secondary to Diverticulitis, A. M.
A. Arch. Surg. 76: 956-962 (June) 1958. (b) Judd, E. S.,
and Smith, M. P.: Present Trends in Surgical Treat-
ment of Diverticulitis, S. Clin. North America 37: 1019-
1027 (Aug.) 1957.

15. Cripps, H.: Cited by Mayfield, L. H., and Waugh.
J. M.: Sigmoidovesical Fistulae Resulting from Di-
verticulitis of the Sigmoid Colon, Ann. Surg. 130:
186-199 (Aug.) 1949.

16. Smithwick, R. H.: Surgical Treatment of Diverticul-
itis of the Sigmoid, Am. J. Surg. 99: 192-205 (Feb.) 1960.

17. Turnbull, R. P.: Personal Communication.

18. Meyer, T. L. : Massive Hemorrhage from Sigmoid Di-
verticula, Am. J. Surg. 99: 251-252 (Feb.) 1960.

19. Colcock, B. P.: Surgical Treatment of Diverticulitis,
Am. Surgeon 24: 738-740 (Oct.) 1958.

326

NORTH CAROLINA MEDICAL JOURNAL

August, 1960

Diagnosis and Treatment of Acute Cholecystitis

William W. Shingleton, M.D.*
Durham

Because of the rapidly increasing number
of older people in the population, the inci-
dence of complications arising from chronic
biliary tract disease is on the increase.
Among these complications is acute cholecy-
stitis. For example, during a 26-year period
(1932-1958) at the New York Hospital,
5,037 operations were performed for non-
malignant biliary tract disease, 1,028 of
which were for acute cholecystitis111. It has
been estimated that approximately 10 per
cent of the entire population have gallstones,
and the incidence is about four times as fre-
quent in women as in men'2'. Approximately
10 per cent of these patients may be ex-
pected to develop acute cholecystitis.

The etiology of gallstone formation is still
unknown in spite of intensive research.
Neither is the mechanism of the development
of acute cholecystitis completely understood.
A common clinical finding in acute cholecy-
stitis, however, is the presence of an im-
pacted stone producing obstruction of the
cystic duct. Although acute cholecystitis may
occur in the absence of cholelithiasis, this is
the exception and not the rule. Most stu-
dents of the disease feel that with obstruc-
tion of the cystic duct, the concentration of
bile in the obstructed gallbladder is in-
creased, giving rise, initially, to a chemical
inflammatory reaction, resulting in edema of
the wall of the organ. This, in turn, leads
to impairment of the circulation and event-
ual invasion of the damaged tissue by bac-
teria. Although bacteria can conceivably
enter the organ from the blood stream by
direct invasion from adjacent organs or
originate from the bile, evidence suggests
that the bacterial invasion occurs most often
via the lymphatic vessels'21. Bacteria can be
cultured from approximately 50 per cent of
acutely inflamed gallbladders, and the most
common organisms recovered are Esche-
richia coli and streptococci1'".

Diagnosis

Cholecystography provides the single most
helpful procedure in establishing the pres-
ence or absence of chronic gallbladder dis-
ease. The most helpful diagnostic procedure

'From the Department of Surgery. Duke University Med-
ical Center, Durham, North Carolina.

in acute cholecystitis, however, is the phys-
ical examination of the patient. The symp-
toms are strikingly uniform in a majority
of cases.

The attack usually begins with the devel-
opment of moderately severe epigastric or
right upper quadrant pain, often radiating
to the back, scapula area, or right shoulder.
The pain is usually quite severe, requiring
narcotics for relief, and is usually associated
with nausea and vomiting. Chills and fever,
or fever alone, develop during the attack.

The physical signs consist of tenderness,
muscle spasm, and rebound tenderness in the
right upper quadrant ; there is often a pal-
pable mass in this area, representing the
distended gallbladder. A mild jaundice is
often present. If perforation of the gallblad-
der has occurred, a palpable mass represent-
ing a walled-off abscess, or generalized peri-
toneal signs representing a bile peritonitis,
will be present.

Laboratory studies in acute cholecystitis
reveal a leukocytosis and, in some cases, mild
elevation of serum bilirubin. Serum amylase
may be elevated in cases associated with pan-
creatitis, which is usually of the edematous
variety. An intravenous cholangiogram may
result in visualization of the common duct
but non-filling of the gallbladder'4'.

Acute cholecystitis must be differentiated
from other acute abdominal inflammatory
conditions, such as perforated duodenal ul-
cer, acute cholecystitis, acute pancreatitis,
acute diverticulitis, hepatitis, and abscess of
the liver. Renal disease and coronary throm-
bosis also should be included in the differ-
ential diagnosis.

Treatment

The patient with acute cholecystitis may
be treated with or without operation during
the acute attack. Although certain physi-
cians may, by choice, treat all their cases by
one or the other of the two methods, many
now hold that the method chosen be fitted to
the individual patient, based upon consider-
ation of a variety of factors bearing upon
the mortality and morbidity of the disease.
Some of the factors are:

1. The duration of symptoms when the
patient is first seen

AuKust, 1960

SYMPOSIUM ON ACUTE CONDITIONS OF THE ABDOMEN

327

2. The accuracy of diagnosis

3. Age of the patient

4. Presence of associated disease

5. Severity of the disease when patient
is first seen.

Prevailing opinion holds that operation
can be carried out in a majority of patients
during the early stages (48 to 72 hours) of
acute cholecystitis with a low mortality and
morbidity, and with a shorter hospital stay.
Large groups of patients treated by both
surgical and nonsurgical methods with no
striking difference in mortality have been
reported. Thus Bartlett1" reported on 592
patients treated surgically and 124 patients
treated nonsurgically at the Massachusetts
General Hospital with a mortality rate of 3
per cent in the surgical cases and 4 per cent
in the nonsurgical cases. Becker";' reported
on 679 patients treated surgically and 381
patients treated nonsurgically at the Charity
Hospital in New Orleans. The mortality rate
in the surgical group was 6.6 per cent, and
in the nonsurgical 5.5 per cent.

The types of operative procedures usually
employed are cholecystectomy, cholecystec-
tomy and choledochostomy, and cholecystos-
tomy. The incidence of exploration of the
common duct during operation as reported
by several authors'"''71 varies between 10
and 40 per cent. It is suggested that the
following conditions constitute indications
for exploration of the common bile duct dur-
ing operation for acute cholecystitis :

1. Palpable stone in duct

2. Jaundice with bilirubin above 5 mg.
per 100 ml.

3. Associated pancreatitis.

It should be pointed out that if the inflam-
matory reaction around the common duct
abscures anatomic identification of struc-
tures in the area, exploration of the common
duct, even when indications exist, may be
deferred and performed as a secondary pro-
edure later.

Cholecystostomy is used in the acutely ill
3r poor risk patient who fails to respond to
lonoperative treatment. The procedure can
ae carried out under local anesthesia with
only slight risk and may be life-saving in this
eriously ill group.

The complication to be avoided, if at all
possible, is perforation of the gallbladder
prior to surgical intervention. At one time
this complication was considered rare ; how-
3ver, the several reported series suggests
that it develops in 10 to 25 per cent of pa-

tients with acute cholecystitis"1. Three types
of perforations occur: (1) perforation into
the free peritoneal cavity, the most serious;
(2) perforation with walled-off abscess, the
least serious; and (3) perforation into an
adjacent viscus, often the colon. The man-
agement of perforation with generalized
peritonitis is cholecystectomy with drainage
of the peritoneal cavity. The treatment of
perforation with localized abscess is initially
a nonoperative program including stomach
suction, antibiotics, and intravenous fluids.
Interval cholecystectomy should be carried
out later. Treatment of perforation into an
adjacent viscus consists of cholecystectomy
with repair of the perforation into the in-
volved viscus.

The principles of nonsurgical treatment
are bed rest, stomach suction, antibiotics,
and intravenous fluids and electrolytes. This
treatment should be continued until the pa-
tient is pain-free and the temperature and
leukocyte count have returned to normal.

An interesting approach with which the
author has had no experience is the use of
procaine block of perirenal or splanchnic
nerve. A Russian surgeon, Ossipov'91, has
recently reported on this technique. It is
my opinion that, as in acute pancreatitis,
regional procaine injection in acute cholecys-
titis favorably influences the acute inflam-
matory process. Patients are initially given
a paranephric procaine block, some of which
respond (no figures given) ; those who do
not respond are operated on during the first
24 hours, under local anesthesia. Under this
method there were 9 deaths in 285 opera-
tions, a mortality rate of 3.1 per cent.

Experience at Duke Hospital

The charts of 100 consecutive cases of
acute cholecystitis treated at Duke Hospital
from 1953 through 1959 were recently re-
viewed. Fifty-one patients were operated
on during the acute attack, and 49 patients
were treated nonoperatively. Thirty-one
were males and 69 were females. Forty-two
patients were under 50 and 58 patients were
over 50 years of age. Twenty-one patients
were over 70 years of age and seven patients
were over 80. Operation was carried out in
the following circumstances :

1. In patients seen early in the disease
(48 hours) who were good or reason-
able surgical risks

2. In patients where diagnosis was in
doubt

:;l'n

NORTH CAROLINA MEDICAL JOURNAL

August, 10(30

4.

In patients who did not respond or
grew worse during medical treatment

In patients who exhibited signs of im-
pending or actual perforation of the
gallbladder.

The results of treatment and type of op-
erative procedure used in the 100 cases of
acute cholecystitis are shown in table 1. One
of the deaths in the surgically treated group
resulted from cardiac arrest which developed
during operation, and autopsy showed, in
addition to acute cholecystitis, marked cor-
onary atherosclerosis. The other death in
the surgical group occurred in a patient who
had acute cholecystitis five days following
inferior vena caval ligation for multiple pul-
monary embolism. The patient was operated
on 24 hours following the onset of abdom-
inal symptoms and was found to have a per-
forated gallbladder, which was removed. The
patient died two days later, presumably from
peritonitis ; no autopsy was obtained.

The one death in the nonoperatively
treated group occurred in a patient who was
admitted to the hospital with signs of gen-
eralized peritonitis and who died 24 hours
later. The cause of the peritonitis was not
established prior to death. Autopsy revealed
a generalized bile peritonitis from perfora-
tion of an acutely inflamed gallbladder.

Certain associated diseases encountered
in the 100 patients treated for acute cho-
lecystitis are of interest. Five patients had
acute pancreatitis. All these patients had a
serum amylase level above 500 Somgyi units
when first seen before operation. Operation
was deferred in all these patients during the
acute attack. Three patients were found to
have carcinoma of the pancreas in conjunc-
tion with acute cholecystitis. In one case
acute cholecystitis developed after an opera-
tion for an unassociated condition.

Summary and Co)iclusions

A review of the diagnostic features of
acute cholecystitis is presented. Diagnosis
can be established in a majority of patients
early in the acute attack. The most helpful
diagnostic procedure is accurate observation
of physical signs associated with the disease.
Intravenous cholangiography performed
during an acute attack may be helpful.

No.

eaths

Mortality

1

2',

2

■I';

1

0

0

1

Table 1
Mortality in Surgical and Nonsurgical Treatment
of Acute Cholecystitis
No.

Treatment Cases

Nonoperative _ 49

Operative 51

Cholecystectomy 40

Cholecystectomy 6

Cholecystectomy \ ,

Choledochostomy /

Cholecystostomy 5

Results of treatment in acute cholecysti-
tis, as reported in current medical literature,
suggest that patients can be treated both op-
eratively and nonoperatively with a similar
mortality.

A review of 100 consecutive patients with
acute cholecystitis treated at Duke Hospital
from 1953 through 1959 shows that approx-
imately one half of the patients were op-
erated upon during the acute attack, and
the other half were treated nonoperatively
Mortality rates were similar in the two
groups. The indications for operation and'
management of complications are discussed
It is concluded that treatment of patients
should be individualized, and that the form
of treatment chosen should be that which is
best suited to the specific situation in each!
individual case.

References

1. Glenn. P.: A 26 Year Experience in the Surgical Treat
ment of 5.037 Patients with Nonmallgnant Biliarj
Tract Disease, Surg.. Gynec. & Obst., 109: 591. 1959

:
Iter

2. Cole, W. H.. and Elman, R: Textbook of Surgery
New York, Appleton-Century-Crofts. Inc.

3. Illingworth, C. F. W. Types of Gallbladder Infection
Brit. J. Surg.. 15: 221. 1928.

4. Sparkman. R. S.. and Ellis. P. R.: Intravenous Cho
lecyst-Cholangiography in Emergency Abdominal Di
agnosis, Ann. Surg. 143: 416-421 (March) 1956.

5. Bartlett. M. K.. Quinby. W. C. and Donaldson, G. A.
Surgery of the Biliary Tract: Treatment of Acute Cho
lecystltis. New England J. Med. 254: 200-205 (Feb. 2:
1956.

6. Becker. W. F.: Powell. J. L.; Turner. R, J.: A Clinica;
Study of 1060 Patients with Acute Cholecystitis. Surg.i
Gynec. & Obst. 104:491. 1957.

7. (a). Boyden. A. M.: Acute Gallbladder Disease and th
Common Duct, A. M. A. Arch. Surg. 70: 374-378 (March
1955.

(b). Dunphy, J. E.. and Ross. F. P.: Studies in Acut;
Cholecystitis: Surgical Management and Results, Sur
gery, 26: 539-547 (Sept.) 1949.

ic). Glenn. F. : Common Duct Exploration in Acut
Cholecystitis, Surg,. Gynec, and Obst., 104: 190. 195'

8. Pines, B.. and Rabinovltch, J. : Perforation of the Gall
bladder in Acute Cholecystitis. Ann. Surg. 10: 170-17
(Aug.) 1954.

9. Osipov, B. K.: The Surgeon's Tactics in the Treatmen
of Acute Cholecystitis, Surgery 46: 507, 1959.

!k

[mli
il

a ci
.

':■.':'

I, SO'

-■v
torn;

August, 1960

329

Acute Surgical Conditions
Associated with Pelvic Endometriosis

Robert A. Ross, M.D.*
Chapel Hill

The problem of endometriosis deserves
deliberate consideration in a symposium
dealing with acute surgical conditions of the
abdomen. The "acute abdomen" generally
is well understood and its importance recog-
nized. Though the qualified surgeon is capa-
ble of meeting emergencies as they arise,
anticipating the correct diagnosis allows for
I better preoperative care, better definitive
I measures, and greater assurance that the
9 patient will be maintained as a normal an-
> atomic, biologic, and psychologic woman.

Diagnostic Criteria
The compelling reason for placing a case

oil of endometriosis in the category of surgical-
ly acute conditions would probably be one
or a combination of several symptoms and
findings : Intra-abdominal bleeding, intesti-
nal obstruction, lower abdominal infection,
bleeding from the urinary tract, and rectal
bleeding are the most common in the acutely
ill patient. The patient would likely be in
the 20- to 40-year age group ; she would give
a history of increasing dysmenorrhea or ac-
quired dysmenorrhea ; the menstrual cycle
probably would have been altered ; if mar-
ried, she might give a history of sterility ;
previous uterine currettement or pelvic op-
erations are not uncommon. The patient
must have or have had a uterus and func-

. tioning ovarian tissue in order to have en-

d dometriosis ; however, intestinal obstruction
can occur after castration or hysterectomy
in patients who have had proven endometri-
osis.

The acute symptom or symptoms are eas-
ier to explain than those of chronic or pro-

;: gressing pelvic endometriosis. A transplant
to the ovary can rupture, giving signs and

..symptoms similar to an ectopic pregnancy

:i or bleeding from a ruptured graffian follicle ;
or it can become twisted, thus actually be-

'".'', coming a twisted ovarian cyst with the re-
lated complications : old blood and cellular

; material can escape from an area of endom-
etrial transplants and give all the evidence

:'~; of acute appendicitis or salpingitis, or such

*From the Department of Obstetrics and Gynecology, Uni-
versity of North Carolina School of Medicine. Chapel Hill.

areas can themselves become infected. Large
and small intestines can become adherent to
endometrial nodules with resulting intestinal
obstruction, or the process can involve the
bowel wall, usually rectosigmoid, and grad-
ually produce obstruction. In two instances
we have been confronted with hematuria
and ureteral pain with symptoms similar to
renal calculus and have found endometrioma
of the broad ligament and pelvic brim with
hemorrhage.

Abdominal palpation or auscultation yields
little that is distinctive. Pelvic examination,
however, may disclose something that could
suggest pelvic endometriosis. Tenderness
and "beading" of the uterosacral ligaments
is a common finding, and there is usually
more fixation of the uterus and adnexae
than one finds certainly in appendicitis or in
a patient with initial salpingo-oophoritis.
Although bilaterality is common in the dis-
ease, usually one ovary and tube is more ad-
herent than the other. The rectovaginal sep-
tum may be obliterated, is unusually tender,
or perhaps has findings similar to ruptured
ectopic pregnancy. Rarely, a suggestive spot
is encountered on the cervix or vaginal mu-
cosa that would add to the suspicion of
endometriosis, but this sign is uncommon.

Treatment
The management of these acute complica-
tions of endometriosis is surgical, but con-
servative treatment is usually possible. The
conservation of ovarian tissue and an at-
tempt to preserve and promote fertility is
laudable and often rewarding. Endometri-
osis is one of the few conditions in which
"piecemeal" surgery in the pelvis is justi-
fied. An infected endometrioma is excised,
usually without drainage ; a bleeding area
is usually removed ; when intestines ai*e ad-
herent or kinked, they are freed and the
implants excised or fulgurated ; when pelvic
viscera are distorted, they are replaced and
raw areas protected. If the patient's con-
dition is satisfactory and if she has had se-
vere dysmenorrhea, pre-sacral neurectomy
could be included and will often give grati-
fying relief. Prolapsed and adherent ovaries
and tubes should be freed and suspended

:;::u

NORTH CAROLINA MEDICAL JOURNAL

Aue-ust, ItiCO

with minimal trauma. A uterus that is path-
ologically fixed in retroversion might offer
one of the few remaining justifications for
the procedure of uterine suspension.

Endometrioma of the bladder and rectum,
usually the anterior wall, sometimes are so
extensive that partial resection of the viscus
is necessary for relief; and if the process is
quite extensive, castration might be neces-
sary. If in doubt, one is usually safe in being
conservative, since castration can later be
accomplished by x-ray.

Culdoscopy carries a hazard in extensive
pelvic endometriosis and is of value chiefly
in the differential diagnosis of obscure pelvic

complaints with little or no palpatory find-
ings.

Conclusion

In a discussion dealing primarily with the
acute complications possible in pelvic en-
dometriosis, it is not necessary to outline the
ideas regarding histogenesis nor to relate
the most recent studies of the response to
endocrine therapy. The background and
current management of this condition make
fascinating study. Such a study is definitely
warranted in the effort to reduce the increas-
ing incidence of this crippling lesion.

Medical and Hospital Costs of the Aged
A Current Appraisal

Walter Polmer, Ph.D.
Madison, Wisconsin

The medical profession is now facing a
problem which it has to a large extent cre-
ated. The United States has a population
of more than 175 million persons, of whom
16 million are aged 65 years and over. The
persons in this age group are increasing at
about twice the rate of the over-all popu-
lation.

Wherever one turns in the literature on
aging there echoes the theme crisply stated
by Piersol and Bortz in the late 1930's : "The
society which fosters research to save human
life cannot escape responsibility for the life
thus extended. It is for science not only to
add the years to life- but more important to
add life to the yeai-s." But will the added
years of life be burdened by disease, illness,
disability, and high medical costs?

Persons aged 65 years and over are be-
coming increasingly aware of the value of
good medical care. Certainly they have rea-
son to be thankful for this type of medical
care. In the past, pain, disability, and seri-
ous illness involved relatively little expense,
because there was little that could be done
for a sick person. Now pain and disability
can often be avoided and death significantly
postponed, but at the cost of more visits to
the physician, more admissions to hospitals,
more use of drugs and other treatments. All
these medical expenses must be met either by
the elderly patient, his family, the physician,

the hospital, or society. In the light of de-
creasing mortality among the middle-aged
and the aged, the recent increases in the cost
of medical care do not seem excessive. In
fact, some authorities believe that we do not
yet spend enough for health care.

Rising Expenditures for Medical Care

As part of their rising standard of living
today, the American people are spending
more money on medical care than ever be-
fore. Part of the increase reflects popula-
tion growth and rising prices ; even on a per
capita basis and with prices held constant,
medical spending has increased. For this
large outlay, the American consumer today
receives a greater quantity and variety of
improved medical services.

Studies by the Health Information Foun-
dation indicate that in 1929 Americans spent
$3 billion for medical care. Over the next
four years, as economic activity contracted,
annual expenditures dropped by about one-
third, reaching just below $2 billion in 1933.
Expenditures for medical care have in
creased each year since then. In 1959 the
public spent an estimated $22 billion, about
7 times as high as in 1929.

Gross expenditures for medical care since
1929 reflect a rise in spending by consumers
not only for the total, but also for each major
component of the medical care index in both

August, 1960

MEDICAL COSTS OF THE AGED— POLMER

331

gross and per capita terms. Payments to
the physician, largest of the components, in
1929 through 1954 rose from $959 million
in 1929 to over $2.5 million in 1957. Al-
though impressive, this increase has been
overshadowed by other components. The
physician's share of the medical care dollar
dropped from 32.6 to 24.5 cents. In contrast,
spending for hospitals rose from $403 mil-
lion in 1929 to $3,884 million in 1957. In
like manner, expenditures for hospital and
medical care insurance rose from $108 mil-
lion in 1929 to $1,064 million in 1957.

Part of the increase in spending for med-
ical care followed the swelling income of the
American people. Disposable personal in-
come — that is, income after taxes — rose
from $683 per capita in 1929 to $1,812 per
capita in 1957. Medical expenditures con-
stituted 3.5 per cent of disposable personal
income in 1929 ; it then rose to 4.4 per cent
in 1932. By 1957 spending for medical care
amounted to 4.9 per cent of the disposable
personal income. The American consumer,
including the aged person, has been putting
greater emphasis on medical care. Medical
care is now becoming an important part of
the American standard of living.

Economists must consider the over-all pic-
ture in analyzing a situation. Analysis, how-
ever, does not prevent the economist from
understanding that- while he may speak of
billions of dollars or millions of people, it is
still the individual aged person and his fam-
ily that is most important. All analysis will
concern large groups. The prime interest of
the research still is the individual.

A large segment of the older population
does not receive active hospital or nursing
care. According to available information,
about 1.8 per cent of all older people are in
the hospital a single day and occupy less
than 20 per cent of the total number of pa-
tient beds in short-term general hospitals.
Yet, the recent report of the Commonwealth
of Massachusetts stated : "Persons past 65
years of age have the highest rates of chronic
disease and disability of any age group. Al-
most one in every two aged persons has a
chronic disease or impairment. While they
make up just 8% of the population, on any
given day, they occupy 18r/( of our general
hospital beds, 22% of our long-term hospital
beds and 80 to 90 '/< of the beds in nursing
homes. In addition, it has been estimated
that 16% of the aged were suffering from a
form of disability lasting more than six

months as opposed to only 3% of the work-
ing age adults. Not only is their average
length of stay longer in the hospital, nursing
homes and other institutions, but aged use
the services of a physician more often than
do any age groups."

The average cost of medical care for those
65 years and over is higher than for the gen-
eral population. The Health Information
Foundation found in the early 1950's that
persons 65 years of age and over averaged
$102 per person in expenditures for private
personal health services, or 57 per cent more
than the $65 per person cost in general pop-
ulation.

The rise in the aged population has
brought about many conferences, institutes,
meetings, and statements of experts. It is
the purpose here to present a background for
viewing the expenditures for medical and
hospital care of the aged based on current
research.

Medical Costs

Let us be practical about this matter of
medical costs. For some, any medical ex-
penditure will be a problem ; for others, vir-
tually no medical expenditure will be a prob-
lem. It becomes important to remember that
we are discussing only the purchase of the
best type of medical care. This is the type
of medical care that will answer the organic
or psychological problem facing the aged.
Apparently no sum is too great for most
people to spend in order to preserve life.
Medical care is not confined to stays in the
hospital or visits to the physician. For the
aged- medical care consists also of preventive
and rehabilitative processes needed to main-
tain the aged person in active life in the
community. Although preventive medicine
is of growing importance, the emphasis here
will be on the hospital and physician charges.
This is because of lack of research on the
actual payments for the rehabilitative ele-
ments of medical care. These elements, how-
ever, are primordial in maintaining the aged
person in the community and lowering fu-
ture medical costs.

The present health conditions of the na-
tion are improving. Besides medical ad-
vances, changes in housing, nutrition, edu-
cation, and employment for the American
people in the last half century cannot be
overlooked. Although preventive medicine,
rehabilitation, and recreation are important,
they will not be emphasized — in order that

332

NORTH CAROLINA MEDICAL JOURNAL

August, 19(10

we can concentrate on more controversial
research.

"Disease" and "Disability"
We have the unhappy habit of using the
words "illness," "disease," and "disability"
as if they were interchangable. The ma-
jority of us have some type of disease. Some
have bad eyes and wear glasses ; others have
sinus conditions or asthma ; others have va-
rying degrees of arthritis. All these are
diseases. Each may be important to the in-
dividual, but the key point is the extent of
disability resulting. Too quickly it is pointed
out that the morbidity of the aged is four
times that of persons aged one to 14. The
key question still is: Does the disease cause
the individual disability and higher medical
costs? If the individual has adjusted him-
self to the disability, as have those of us
who wear glasses, does the condition really
matter? A chronic disease does not neces-
sarily constitute a chronic illness problem.

Large Bills for Medical Care
Hardly anyone likes to pay a doctor's or
hospital bill ; the majority of us never do
pay a high bill. In a recent survey made by
the magazine Medical Economics to deter-
mine the highest bills charged by physicians,
the median highest charge for 171 special-
ists was $650. Most bills for medical care
in any one year are less than $300. The
majority of the people do have more than
$300. A recent survey by the New Jersey
Blue Cross shows what this would mean.
The New Jersey Blue Cross has a 120-day
basic hospital care plan. Their study indi-
cated that out of every 100 claims filed under
this plan, 90 were paid in full by the plan.
Six were paid partially by the plan and only
four went into the area of extended, high-
cost medical care. Therefore, probably less
than 10 per cent of those receiving hospital
care have high medical bills. The National
Health Service has shown that approximate-
ly 90 per cent of the aged who enter a short-
term general hospital are discharged in less
than 30 days. These persons, however, fear
that they will be one of those 10 who remain
more than 30 days. They fear that they will
be among those 4 whose bills will extend be-
yond the 120 days of the basic Blue Cross
policy. This is a situation which we must
come to grips with.

Does anyone really want to cut the high
expenditures for medical care? Would the
aged person prefer to do without medical

and hospital care rather than pay for these
services? Would the physician prefer to give
his patient less than the best possible med-
ical management? Would the hospitals rather
not have the radioisotope department take
care of patients? I think the answer is that
everyone wants the best possible type of
medical care and is willing to pay for it, if he
can.

Medical expenditures have been rising
since 1945. We do not have the statistics
for the entire aged population, but we do
have them for the population as a whole.
We may have paid too much attention to
the relative increase in medical costs and too
little to what medical care would have been,
had these expenditures not been made. At
the present time the entire population pays
about $2,500,000,000 for physician services
as contrasted with about $1,500,000,000 in
1949. When it is considered that in the same
period of time the national income rose from
$400 billion to approximately $440 billion
this does not seem a very great rise. The
same should be said for hospital costs. We
have doubled hospital expenditures since
1949— from roughly $2 billion to $4 billion.
This may not be too great a price to pay
for an increase of over 150,000 new hospital
beds. A hospital bed must be paid for wheth-
er it is being used or not. The hospital must
be ready to take care of the patient in emer-
gencies, and it costs roughly 70 per cent of
the cost of an occupied bed to maintain an
unoccupied bed.

Paying Medical Care Costs

These figures are averages, but are the
aged able to pay for these services? One
report stated that 60 per cent of the aged
have an annual income of less than $1,000.
The aged are not isolated. The majority are
living either with their spouses or with a
family. For example, there is the aged wid-
ow who would normally move in with the
daughter's family, if at all possible. This
widow has a very small income, but she prob-
ably pays no rent and receives some type of
income from the daughter's husband whether
he likes it or not. In a medical crisis the
family will, according to recent research,
come together to aid the mother. The mat-
ter of income is not the entire story of the
aged's resources to pay for acute illness.

By the time the aged person has left the
labor market or entered widowhood, there
has been an accumulation of assets and in-

August, 1960

MEDICAL COSTS OF THE AGED— POLMER

333

come. The direct income from labor market
activity may not be too great- but the in-
come based on assets may be of great value
in a "crisis." As an example, in 1959, an-
nuities based on past income paid to those
over age 65 came to nearly $450 million a
year. Whether the aged person will consider
this income or annuities is a question which
research can throw little light on.

According to available research, the ma-
jority of aged persons pay their entire
charge to the hospital and the physician.

Voluntary Health Insurance
We have been discussing this entire ques-
tion of medical expenditures as if voluntary
health insurance did not exist. Of course it
exists and is utilized by an increasing num-
ber of aged persons. In 1951 it was esti-
mated that about 1,800,000 persons aged 65
and over, or 15 per cent, were covered by
voluntary health insurance. By 1958, 43 per
cent or 6,600,000 aged persons were being
covered by voluntary health insurance. Last
year the expansion of Blue Cross-Blue Shield
and other health insurance plans have prob-
ably increased this number much more.

In the past, we have stated that voluntary
health insurance among the aged increases
at a rate of approximately 3 per cent a year.
If we use this conservative figure, at least
47 per cent of the total aged have voluntary
health insurance. Yet there are many aged
persons who for religious and other reasons
do not want voluntary health insurance or
who can receive the same benefits without
paying for it. Research provides some idea
of the categories involved. We do not have,
however, exact figures as to the number of
veterans who look upon the local Veterans
Administration hospital as "their voluntary
health insurance" benefit. The Health In-
surance Association of America estimated
that in 1957 between 3 to 5 million persons
could be included in the group that does
want or need voluntary health insurance. If
you take the mean of 4 million persons, an
increasing coverage has been already pro-
vided for the aged by voluntary health in-
surance.

Voluntary health insurance seems to be
doing a good job for the majority of the
acutely ill aged people who have it. A re-
cent survey published by the U. S. Depart-
ment of Health, Education and Welfare
stated that only 14 per cent of the couples
and 9 per cent of the individuals under Old
Age Survivors Insurance received any bene-

fits from their voluntary health insurance
to help pay for medical care. This, of course,
is true. In order to determine what was be-
ing spent for all medical care, the OASI
attempted to survey all expenditures for
medical care such as osteopathic services-
physicians' services, faith-healing, nursing
home care, dentistry, hospital care, ethical
and proprietary drugs. The result was ex-
actly what everybody expected. The major-
ity of aged people do not go into the hos-
pital and do not receive any aid from vol-
untary health insurance. It is one thing to
say that expenditures for proprietary drugs
is a medical care cost. I do not think that
anyone will argue with the fact that for
many this is true. Should voluntary health
insurance pay for the purchases of aspirin,
vitamins and antibiotics? The decision may
well be that they should. If so, the cost of
voluntary health insurance may go much
higher than it has in the past. According to
the statistics of the OASI survey, approxi-
mately 20 per cent of the OASI couples used
the hospital within a year. This would
mean that while 43 per cent of the aged had
voluntary health insurance, it may be that
close to 65 per cent of all of those who were
hospitalized received aid from voluntary
health insurance.

The quality of coverage provided by vol-
untary health insurance is quite important.
There has been no study at the present time
that can tell us the amount of the total hos-
pital and physician charge to the aged paid
for by voluntary health insurance. Part of
the research problem has been that for cer-
tain diseases voluntary health insurance does
not provide aid for needs such as cosmetic
surgery or psychotherapy. Yet research in
Michigan Blue Cross on the aged seems to
show that approximately 90 per cent of all
hospital bills of the aged were paid for by
voluntary health insurance. Whether it
should be 100 per cent is a question which
I think should take additional study.

Statements to the effect that voluntary
health insurance cannot provide coverage for
the aged come from persons who have not
tried to provide it. As an example, in 1938
the Federal Government called a conference
on voluntary health insurance. The report
found that because of the low income of the
people of the United States, the voluntary
health insurance movement must fail. "The
conclusion is inescapable that considerable
proportions of the nation's families are too

.334

NORTH CAROLINA MEDICAL JOURNAL

August, 1960

poor to afford the cost of adequate medical
care from their own resources. In the face
of needs which are vital and urgent for, at
least, 100 million persons in the United
States, the Technical Committee on Medical
Care cannot find the answer to the nation's
problem in voluntary insurance methods."

"Fortunately, the voluntary health insur-
ance movement went ahead and provided
coverage. They did not stop to listen to the
experts who told them it could not be done.
By now we have coverage for approximately
71 per cent of the entire population. It is
estimated that- possibly by 1975, a large ma-
jority of the aged who need and want vol-
untary health insurance will have it. By
1958, for example, the number of Blue Shield
plans that will enroll persons over age 65
had risen from 8 to more than 30 plans,
with many more planning to provide such
coverage within this coming year.

Catastrophic Illness

The problem, however, facing many of the
aged is not only one of actual medical ex-
penditure. It is the fear of a high medical
expenditure in the future. Almost everyone
knows someone who has had to pay $1,000
or $2,000 for medical care. In essence, we
are discussing the chronically ill of any age.
It is expensive to be ill. Chronic illness
drains the resources of the individual and
the family in time. The 85 year old person
with chronic arthritis and the Mongoloid
child are both chronically ill. Their needs
must be provided for. Research seems to
suggest a way by which this can be done.
It has been only 10 years since the concept
of "major medical" or prolonged illness con-
tract appeared on the American scene. Ten
years ago anyone who said that there could
be a major medical plan for over $5,000 was
laughed at. Today they are selling major
medical plans for $10 to $20,000. In Massa-
chusetts, the Massachusetts Blue Cross-Blue
Shield has an experimental program to find
out about what it would take to sell a $5,000
"Master Medical" or "Prolonged Illness"
program to the aged. One firm is already
providing $15,000 worth of major medical
benefits to their retirees. With the inflation-
ary trend, $5 to $15,000 may be too small in
the future. Perhaps it may be necessary to
go to $40 or $50,000 in order to make sure
that the chronically ill costs of that small

group of the aged are adequately taken care
of. If a reasonable deductible clause and a
reasonable coinsurance feature are included,
it may be possible to sell these policies. At
the same time, the basic contract coverage
must be extended.

Summary

In facing the problem of those in the older
age groups who are in need of medical, eco-
nomic or social aid, one can enumerate as-
pects of that problem, devise solutions, and
eventually try to coordinate the different
solutions into a program. One can also take
one of the numerous solutions in the litera-
ture and accept it as the answer. I prefer
the former pragmatic approach. There are
certain problems of medical care expendi-
tures among the aged. They must be met.
There is not one single problem, but a whole
series. Perhaps the solutions presented by
an English doctor is one for us to contem-
plate. "A completely unified and regimented
service on the behalf of the aged would be
akin to the nature of the problem but would
defeat any attempt to distribute responsi-
bility for them among all classes of the com-
munity and might lessen public concern.
Certainly, it may be unwise to allow the idea
to gain substance that care of the aged will
be taken over completely by the diffuse father
figure of the state." We are all involved, for
health like happiness is an objective always
to be sought even if it can never be fully
obtained.

In the recent book, The Image of America,
R. L. Bruckberger, a French Dominican
Father, pointed out that our country has
demonstrated a genius for solving social
problems that have baffled mankind for gen-
erations. There is very little marriage to
dogma and ideology, but a great national
confidence that we can find solutions to our
difficulties. This has resulted in the willing-
ness to experiment, to explore, to be flexible
in our approach to social and economic prob-
lems and developments. The question of
paying for medical care by the aged will be
met in the same way.

(Note: An extensive bibliography has been prepared for this
article. It may be obtained from the editor).

August, 1960

ADVERTISEMENTS

XXV

One way or another people will seek
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Whether you like it or not, prepay-
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Concerning Your Health and Your Income

A special report to members of the Medical Society of

the State of North Carolina

on the progress of the Society's

Special Group Accident and Health Plan

in effect since 1940

PROUDLY WE REPORT 1959

AS OUR MOST SUCCESSFUL YEAR IN SERVING YOUR SOCIETY.

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1960

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Originator and pioneer in professional group disability plans.

August, 1960

335

Medical Problems Facing Congress

Sam J. Ervin, Jr.*
Washington, D. C.

It is a great privilege to be here today
and to talk to you who practice the healing
art. Any member of a legislative body is
necessarily concerned with public health,
because the government has been concerned
with this problem for generations.

We have many problems in Washington,
but I'm inclined to think that some of the
solutions offered are worse than the prob-
lems. We have a very loquacious member
of the Senate in the person of Hubert
Humphrey. Some newspaper man writing
about him a few days ago said he was the
only man in public life who had had more
solutions than there were problems. Inci-
dentally, I think maybe the medical pro-
fession has a few unsolved problems of its
own.

The Government's Role in the
Field of Health

I want to talk this morning, as briefly
as any member of the United States Sen-
ate can talk, about the place of the federal
government in the field of health. I think
the federal government has a real place in
this field, and one that has probably become
more important as a result of existing con-
ditions.

The most astounding advances have been
made in medicine during the past quarter
century than in any other field of life. In
the old days a doctor could carry the tools
of his profession in a small bag, but with
the advancement of medical science, the
cost of treatment, when considered on a
nationwide basis, has become enormous.

In the days before the astronomical rise
of the national budget, when Congress
thought that perhaps the taxpayers knew
better how to spend their income than Con-
gress did, and when income taxes were
either nonexistent or low, many people
were able to make great contributions to
causes and institutions such as hospitals
and medical schools. But as time passed
and the national budget rose from $3 bil-
lion in 1930 to $79.8 billion in 1960, the

Reporter's Transcript of an address delivered before the
First General Session of the Medical Society of the State of
North Carolina, Raleiffh. May 9, 1060.
"Senior Senator from North Carolina.

federal government has been confiscating
large parts of the individual personal in-
come of the American people by way of the
federal income tax. As a result, it has be-
come virtually impossible for people to
amass large fortunes as they did in times
gone by, and consequently individual gifts
to medical school and hospitals have great-
ly diminished. This factor has added to the
difficulties confronting the nation at this
time.

From the time that the Marine Hospital
was established in 1797 down to this day,
the federal government has had a real
place in the field of public health. Today,
as you know, it makes grants to state and
local health authorities for general pur-
poses and sometimes for specific ones.

Then the federal government I think, has
a right, under the Hill-Burton Act, to as-
sist the states and communities in the erec-
tion of hospitals. This program has been
extended of late to include nursing homes.

The federal government, I believe, has a
real place in the field of medical research
and is doing a fine job in the National In-
stitutes of Health in Bethesda, Maryland.

As a result of the inability of the Amer-
ican people to make large gifts to medical
schools, the federal government can help
(1) through cooperative arrangements with
the faculties of medical schools in the re-
search field, and (2) by providing fellow-
ships and traineeships to medical students.
Also, I think the government has done a
fine thing in establishing the great insti-
tution which we now have in Cincinnati
for study in that very essential field of
public health.

Objections to Pending Bills

I know you are interested in some of the
medical problems now confronting Con-
gress, and particularly in the Forand bill.
A number of other proposals are pending.

If I controlled the situation, I would
postpone any consideration of these bills
until next January, simply because most of
them, when analyzed, appear to be designed
to promote or protect the political health
of some members of Congress, rather than

336

NORTH CAROLINA MEDICAL JOURNAL

August, 1960

the health of the people in whose behalf
they are supposed to be offered.

Frankly, I believe that a serious problem
exists in this field — one which merits the
consideration of the medical profession, the
Congress, the states, and local communi-
ties. But I do not think that any of the pro-
posals made thus far are the correct solu-
tions.

With no wish to be partisan, I refer first
to the Administration Program — a hodge-
podge proposal, thrown together hurriedly
merely as what you would call a counter-
irritant to the other political bills on this
subject.

Contrary to Social Security concept

These proposals have several fundamen-
tal objections. In the first place, being
geared to Social Security rules, they in-
volve a serious question as to whether or
not we should depart from the original
concept which underlies the system.

This idea was that, while the system was
compulsory in nature, when a person be-
came eligible for Social Security benefits
he was to receive them as a free man ; that
they belonged to him, and that he was to
have the privilege of doing what he wished
with them.

A bill which undertakes to place the cost
of medical and hospital care under the So-
cial Security system is an absolute depar-
ture from that concept, because it provides
that the contracts are to be made by the
Secretary of the Department of Health,
Education and Welfare, except when he
might delegate that authority to some one
of the insurance companies. Furthermore,
he not only makes these contracts but han-
dles the monies for all recipients of Social
Security benefits. So one serious problem
confronting the American people and the
Congress is whether or not they are going
to depart entirely from the original Social
Security concept that a man should be free
to handle his own funds.

These bills say, of course, that a man can
select his own surgeon and his own hos-
pital. This is not exactly true, because he
can select only a surgeon or a hospital hav-
ing a contract with the Secretary of Health,
Education and Welfare, or with the dele-
gated agent of the Secretary. Furthermore,
he is denied the right to make any con-
tract with respect to his treatment, because

he cannot contract to pay the hospital or
the surgeon a cent more money than that
which is to be paid by the government un-
der the contract with the Secretary or his
agents.

Fail to help the neediest

One objection, as I see it, to these bills
in their present form is that, except the
Administration bill and the McNamara bill,
none of them provides any assistance what-
ever for the people who need it the most.
As a general rule most of the people on
Social Security can meet their own medical
expenses.

At the risk of being charged with the
same offense as was a storekeeper that I
will now tell you about, I want to present a
few statistics. A certain mountaineer who
had been buying groceries on credit at the
neighborhood store received a bill which
was considerably more than he thought it
ought to be. When he complained, the gro-
cer got out the account book, laid it on the
counter, and said: "Here are the figures;
look at them yourself. Figures don't lie."

The mountaineer said, "No, figures don't
lie, but liars sure do figure."

At the risk of falling into that category,
I wish to quote some figures that I think
are germane to this matter. There are ap-
proximately 16 million people in the United
States of the age of 64 and up, who are
now called aged people in legislative par-
lance in Washington. Of these approxi-
mately 2,250,000 receive Old Age Assist-
ance. They are, in a sense, financially desti-
tute. They are the people who normally
need medical, surgical or hospital treat-
ment the worst, but are the least able to
provide it for themselves.

Such measures as the Forand bill make
no provision whatever for this group of
people. Benefits are confined to those who
are receiving Social Security, and the aver-
age person on Social Security, even though
he be 65 or older, can pay his own medical
and hospital bills. The records show that
these bills average approximately $125 in
the course of a year, and most Social Se-
curity beneficiaries can handle that.

Now, the people who receive Old Age
Assistance do so because they are destitute.
If there is any group of people that are in
need, not only of the necessities of life but
also medical care, it is they. It is true they
receive some medical benefits through the

August, I960

MEDICAL PROBLEMS FACING CONGRESS— ERVIN

337

Welfare Service, and I think that those
benefits should be expanded.

Another group of persons that I think
the medical profession, the Congress, and
the state legislatures and state health
authorities must consider are elderly peo-
ple who have just enough property to be
ineligible for Old Age Assistance but who
would be destroyed financially by chronic,
protracted illnesses.

The average person under the Social Se-
curity system does not come within this
group, which constitutes only a minority of
our elderly citizens. But there must be some
system whereby discretionary power would
be given the public health authorities to as-
sist these persons, and there should be pro-
vision through the Welfare Service to help
those in a more expanded way on Old Age
Assistance.

Fundamentally, the trouble with the cur-
rent proposals is that they do not help the
people who are most in need of aid. Politi-
cians are funny when they start doing
something: they want to be like the rain
which falls on the just and the unjust alike.
In this case, they want the benefits to fall
on the needy and those that are not needy.
They treat them exactly the same. That is
precisely what these bills do.

For that reason, since they exclude peo-
ple on Old Age Assistance and make no
provision for those with limited means who
suffer for long- periods of time, are chron-
ically ill, and ought to have some discre-
tionary relief rather than relief which ap-
plies to all alike, I am opposed to such leg-
islation.

Limited benefits

The bills are inadequate for another rea-
son. They are limited. Under these bills —
the Forand bill, for example — a man can
get two months of hospital treatment. That
wouldn't help anyone who was sick for
months and months or a person who is
chronically ill for several years. It is true
he can go to the hospital for two months,
but then he would have to get along as best
he could, and it would be 10 more months
before he would be eligible to go back to
the hospital. Furthermore, provision is
made for surgical but not medical treat-
ment. The tragedy is that every day I re-
ceive letters from old people urging that
certain bills be passed, when most of the
writers wouldn't receive a single penny

under any of them, with the possible ex-
ception of some phases of the Administra-
tion bill, which, as I say, is a hodge-podge
hurriedly thrown together as a counter-
irritant for the other bills. It is a tragedy
that the old people of this country have
been deceived about the contents of these
bills. They think all their medical expen-
ses, all their hospital expenses, and all their
surgical expenses would be covered, where-
as the neediest people wouldn't receive any
benefits whatsoever.

Threat to doctor-patient relations

To me one of the greatest relationships
that exists is that of patient and physician.
These bills would certainly interfere with
that relationship because, while they pro-
fess that the man is free to select his sur-
geons or free to select his hospital, he has
to select a hospital or a surgeon who is
under contract with the Secretary of
Health, Education and Welfare or his
agent. Furthermore, he cannot contract,
however much he may need it, if he goes
into a hospital under one of these bills,
above the contracted for price of the hos-
pital. Under the contract with the Secre-
tary, he cannot make any contract to pay
any more, even though he may need more
than he is allowed.

One thing is certain : when the federal
government begins to pay medical bills di-
rectly, the next step is standardization, and
you are going to have standardization un-
der the auspices of the federal government
if one of these bills is passed. The Secre-
tary of Health, Education and Welfare is
to write regulations to carry out the pro-
visions, and I doubt whether any of you
physicians, except those engaged in public
health work, really understand what this
means.

The last time I was engaged in the active
practice of law, I subscribed to the publi-
cation known as the Federal Register,
which contains all tederal regulations. As
the issues came out, I had them bound and
placed in my office for a period of 18
months. The regulations and changes in
regulations for only 18 months occupied a
space of about 28 inches, by actual meas-
urement.

You are going to have these regulations,
and you are going to have things stand-
ardized, and you are going to destroy one
of the greatest human relationships known

338

NORTH CAROLINA MEDICAL JOURNAL

August, 19G0

to man, the relationship of physician and
patient; and for that reason I look upon
these bills with grave misgivings.

To repeat, I do think there is a problem
here, but it lies in the case of persons on
Old Age Assistance and those who have
just enough to be excluded from that un-
fortunate group, but not enough to bear the
cost of a loii • illness. That is a problem
that the medic?.] profession, the Congress,
the state legislatures, and public health
authorities must be concerned with. A solu-
tion must be found, but I do not think that
it lies in the adoption of a system under
which the federal government assumes the
responsibility for the medical needs of
virtually all of our elderly citizens. The peo-
ple who should be helped are those who
need help, and the rest should be allowed
to act as free men and free women, as the
Social Security system in its original con-
cept contemplated.

I return to what I said at the beginning
of this talk: that the kindest thing that
can be done with this serious problem of
the chronically ill is to postpone further
discussion until the atmosphere is free
from the political bargaining which is now
going on in Washington in reference to the
Presidential election of 1960.

Voluntary Health Insurance
In my opinion, the problem of the chron-
ically ill cannot be met entirely by the vol-
untary insurance program. That is a mar-
velous program, however, and I want to call
your attention to the astounding increase
in the number of persons protected by
it. The figures for 1957 indicate that
121 million people in the United States, or
72 per cent of the total population, had
hospitalization insurance of some kind, as
contrasted with 37 per cent who had hos-
pital insurance 10 years before.

In 1957, 109 million persons in the United
States (55 per cent of the total population)
had voluntai-y insurance policies which took
care of the hospital and surgical costs to

some extent. In 1957, 57 per cent had
health policies which provided for the pay-
ment of medical treatment, as distin-
guished from surgical treatment, in addi-
tion to hospitalization. In view of these
figures, we should refrain from adopting
any system which would tend to destroy
the willingness of the American people to
procure hospital, surgical, and medical in-
surance on their own volition.

The amounts paid under these plans is
astounding. Also in 1957, 57 per cent of all
the cost of hospital services in the United
States and 31 per cent of all bills for sur-
gical and medical expenses was paid by
these voluntary plans. I hope that the
services rendered by such organizations as
Blue Cross and Blue Shield, which are do-
ing a fine job in North Carolina, continue
to expand, and that they will be even more
widely accepted.

Some of the companies today are at-
tempting to devise policies that cover the
needs of the aged. One of the main argu-
ments used for the Forand bill is the great
spread of difference between the nonprofit
organizations, which return about 97 per
cent of their premiums in services to their
policyholders, and the private insurance
companies, which do not do anywhere near
that well.

Conclusion

I believe in the expansion of nonprofit
organizations. But when voluntary insur-
ance is improved and extended, the prob-
lem that will still confront the medical pro-
fession, Congress, and the states is that of
people receiving Old Age Assistance, and
of those suffering long illnesses who are
barely ineligible for Old Age Assistance.
That is the problem that should concern
you as well as the Congress and the state
legislature.

Whatever we do, we must see to it that
the personal relationship of physician and
patient is preserved.

The doctor's wife is truly the unsung hero of Medicine, because the
extra hours of faithful service to patients and the hours spent attending
medical meetings and studying the medical literature must be subtracted
from the time the doctor would otherwise spend with his family. It has
been said that the wife has the doctor when no one else wants him. —
Rouse, M.O., South. M.J. 53:1 (Jan) 1960.

August, 1960

339

Leptospirosis

Report of a Case

William A. Leonard, Jr., M.D.

Greensboro

For the past decade veterinarians have
called attention to the occurrence of disease
due to Leptospira in animal life in temper-
ate climates. The disease in man has re-
ceived some recent notice, but is probably
more widespread than is generally known.
In North Carolina it received wide recog-
nition in 1942-1944, when it was deter-
mined that so-called "Fort Bragg Fever"
was due to Lept. autumnalisa) . Sporadic
cases have been reported since12', but the
following is believed to be the first case re-
ported from Guilford County.

It has been demonstrated in this state
and elsewhere that a wide variety of do-
mestic and wild animals harbor the organ-
ism(3). The infection apparently presents
a chronic problem in animals, with the ex-
cretion of Leptospirae in the urine for pro-
longed periods. Contrary to an earlier con-
cept, apparently any animal may harbor
any one of a variety of recognized serotypes
of the organism which are present in the
United States. In other words, there is no
apparent animal or syndrome specificity.

Weil's disease, a fulminating form char-
acterized by fever, jaundice, renal damage
and hemorrhage, was originally presented
as the classic form of the disease in man.
In more recent years it has become obvious
that the more common clinical syndrome is
presented by a mild type of infection not
unlike grippe, influenza, nonparalytic polio,
or aseptic meningitis. Again, as in animals,
any one of the leptospiral serotypes may
result in a similar clinical picture. This
similarity to other common and benign ill-
nesses has undoubtedly been the main de-
terrent to its recognition.

Case Report

A 39 year old white male carpenter was
well until two days before admission, when
he noted the sudden and progressive de-
velopment of profound fatigue, followed
shortly by frank chilling, generalized mus-
cular aching, a moderate generalized head-
ache, and a fever of 104 F. The past his-
tory was not contributory.

Physical examination revealed an acute-
ly ill, toxic individual in obvious discom-
fort. The conjuctivae were suffused. There
were fine crepitant rales at the base of the
right lung posteriorly and laterally. The
heart was not remarkable exceot for an
apical rate of 120. The abdomen was slight-
ly distended but non-tender. The liver and
spleen were not palpable, and no hepatic
tenderness was demonstrated on percus-
sion. The pharynx was minimally injected.
No significant adenopathy was noted. The
remainder of the examination was entirely
within the limits of normal.

Laboratory findings: A urinalysis was
negative. The blood count showed 8,500
white cells, with 86 polymorphonuclears, 1
eosinophil, 1 monocyte, and 12 lympho-
cytes. A serologic test for syphilis was neg-
ative. An electrocardiogram was within the
limits of normal except for a sinus tachy-
cardia. Roentgenograms of the chest showed
prominent pulmonary markings at the
right median base.

The initial clinical impression was that
of primary atypical pneumonia of unknown
etiology. Because of the patient's toxic
state, however, he was started on thera-
peutic doses of chloramphenicol. Because of
doubt concerning the diagnosis, blood was
drawn at the time of admission for possible
agglutination determinations later. A blood
culture was not obtained.

Since antibiotic therapy had obviously
brought about little improvement within 48
hours, it was discontinued. (Antibiotics
have only questionable value in leptospiro-
sis) (4). At this time, the fine crepitant rales
were continuously noted at the right base,
and a few rales were present in the left
base posteriorly. The patient continued to
be acutely ill, and symptomatic treatment
was used to control the muscular aching.
The febrile course is noted on the accom-
panying chart (fig. 1). At this point, be-
cause of the continued presence of marked
conjunctival suffusion, the possibility of
leptospirosis was considered.

:to

NORTH CAROLINA MEDICAL JOURNAL

August, 1960

105°

\

1

1
1

104

103

\

b

102

ff

\

A

r

101

1

r

\/

\

J

\

100

V

V\

986

v\

Day of

3

4

5

6

7

8

9

10

illne ss

1

Fig. 1. Clinical course.

The fever and symptoms gradually di-
minished until the sixth day of illness, when
the patient felt reasonably well. On this
evening- he was intermittently confused and
disoriented. He awakened on the seventh
day with a moderately severe headache, and
nuchal rigidity was observed. A lumbar
puncture was done, with an initial pressure
of 230 mm. of water and a final pressure
of 130 after the gradual removal of 10 cc.
of a hazy fluid. The specimen contained 300
cells per cubic millimeter, predominently
lymphocytes. The protein was 86 mg. per
100 ml. and the sugar 76 mg. per 100 ml.
Culture was sterile on routine media.
Fletcher's media was not available. The
onset of the meningitis on the seventh day
of illness and the characteristic spinal fluid
changes'"" appeared to confirm the clinical
impression of leptospirosis.

As will be noted on the accompanying
clinical chart, the patient had some eleva-
tion of temperature following the onset of
headache and stiff neck. The removal of
spinal fluid promptly relieved the headache,
which did not recur, and on the following
day the patient felt well. Several days after
discharge from the hospital he complained
of visual blurring and was referred for
ophthalmologic consultation with the pre-
sumptive diagnosis of leptospiral iridocy-
clitis. The consultant agreed and success-
fully treated the patient with topical ster-
oid therapy. The subsequent course has
been uneventful.

The pattern of antibody titer is shown in
figure 2.

Comment

When the diagnosis was initially sus-
pected, the patient and his family were

questioned in detail concerning possible
modes of exposure to the leptospiral organ-
ism. His occupation as a carpenter was not
considered hazardous. He had not been
swimming or wading in pools or streams
that might have been contaminated. Four
hunting dogs were kept penned on his pro-
perty, but he admitted little or no contact
with them. The State Board of Health in-
vestigated his home situation and initially
determined that he had recently helped re-
model an old house which was apparently
infested with rats. The dogs were bled and
all found to be positive to Lept. canicola.
Since surveys had shown a percentage of
healthy dogs to be chronic renal shedders1'"
and since Lept. canicola was the serotype
apparently responsible for the patient's ill-
ness, it seemed reasonable to assume that
the dogs were the source of the infection.

Although the patient was exceedingly un-
comfortable, the disease had a relatively
brief and benign course. The iridocyclitis
represented the sole residual defect, and
this condition cleared with proper therapy.
The complication has been previously re-
ported"'". The suffusion of the conjunctiva,
which was present in 85 per cent of Ed-
ward's cases'71, actually presented the first
clue to the proper clinical diagnosis.

The biphasic course of the disease is well
demonstrated by this case. It will be noted
that although the patient was clinically im-
proved on the sixth day of his illness, he
became somewhat confused and on the sub-
sequent day showed obvious physical signs
of meningitis. Whether this manifestation

L. autumnalis

neg.

4 +

14-

L. australis A

-

4 +

1 +

1 +

L. ballum

4 +

L. bataviae

3+ j

-

L. canicola

-

4 +

4+

L. hebdomalis

-

3 +

-

L. hyos

-

-

-

L. icterohem

-

3+

1+

' L. pomona

-

3 +

14-

L. pyrogenes

-

2 +

-

L. sejroe

-

3*

~I+ ~~

L. grippotyph

-

3+

Day from onset
of illness

7th.

14th.

26th.

Fig. 2. Serial agglutination determinations.

August, 1960

LEPTOSPIROSIS— LEONARD

341

might be more properly referred to as men-
ingoencephalitis is not clear at this time.

The explanation for the biphasic pattern
has not been clarified. There is apparent
general agreement that the first-stage man-
ifestations are directly related to leptospi-
remia. A positive blood culture is said to be
possible only during this phase. The role of
hypersensitivity in the pathogenesis of the
second phase has been mentioned by sev-
eral authors. Middleton'71 proposed a hy-
persensitivity reaction to account for the
neurologic lesions, and Davidson18' con-
sidered "after-fever" to be an allergic phe-
nomenon. Edwards' 6el also expressed the
opinion that the second stage appeared to
be the consequence of the body's immuno-
logic responses.

In this temperate climate leptospiral in-
fections probably have seasonal variation,
in contrast to the lack of variation in trop-
ical areas where animal and human activ-
ities, high humidity, and temperatures are
more constant. Humbert'2' considered the
wet spring months, with their high waters
and floods, a possible high-incidence period.

Headache is present in all and conjunc-
tival suffusion in 85 per cent of the cases.
A macular or maculopapular generalized
eruption appears between the fourth and
eighth day in 25 per cent. Nonspecific gas-
trointestinal symptoms are commonly pre-
sent, and a generalized lymphadenopathy
occurs in 40 per cent. The incidence of
meningitis in these cases is not known, but
it appears to develop on or about the
seventh day of illness. Hepatomegaly, icter-
us, and albuminuria may be present, but
splenomegaly is rare. Cough is reported in
25 per cent of the cases and pneumonitis is
seen radiographically19'. From a review of
the available literature, the pulmonary find-
ings do not appear to have been adequately
investigated.

From this summary of the symptoms and
physical findings it is clear that the syn-
drome may mimic many common infec-
tious diseases. It would appear that milder
forms of leptospirosis have gone unrecog-
nized, and it remains for us to encourage a
search for the disease by simple laboratory
procedures in all cases of obscure and un-
explained febrile illnesses.

Summary

A case of leptospirosis caused by Lept.
canicola is reported. It is considered to be
the first such report from Guilford County.

The widespread animal reservoir of in-
fection in this state is noted.

The diagnosis should be considered in all
acute febrile illnesses associated with head-
ache, temperature elevation, myalgia, con-
junctival suffusion, pneumonitis, and where
"asceptic meningitis" or other cerebral
symptoms develop on or about the seventh
day.

It is further suggested that suitable cul-
ture material be made available at the lo-
cal county health level for possible earlier
diagnosis.

References

1. Gochenour, W. S. Jr., and others: Leptospiral Etiology
of Fort Bragg Fever. Public Health Rep. 67:811-813
(Aug.) 1952.

2. Humbert. W. C: Leptospirosis; Its Public Health Sig-
nificance. North Carolina M. J. 16:406-409 (Sept.) 195B.

3. Division of Epidemiology; North Carolina State Board
of Health: Leptospirosis, Bull., State Board of Health,
Raleigh, 1958.

4. Hall, H. E., and others: Evaluation of Antibiotic
Therapy in Human Leptospirosis, Ann. Int. Med. 35:981-
998 (Nov.) 1951. (b) Fairburn. A. C. and Semple
S. J. G. : Chloramphenicol and Penicillin in the Treat-
ment of Leptospirosis Among British Troops in Malaya,
Lancet 1:13-16 (Jan. 1) 1956. (c) Broom, J. C, and
Norris, T. S.: Failure of prophylactic oral penicillin to
inhibit a human laboratory case of leptospirosis. Lancet
1:721-722 (April 6) 1957. (d) Russell, R. R. W.: Treat-
ment of leptospirosis with oxytetracyclin. Lancet 2:1143-
1145 (Nov. 29) 1958

5. Cargill, W. H., Jr., and Beeson, P. B.: The Value of
Spinal Fluid Examination as a Diagnostic Procedure in
Weil's Disease, Ann. Int. Med. 27:396-400 (Sept.) 1947.

6. (a) Sturman. R. M., Laval. J. and Weil. V. J.: Lepto-
spiral Uveitis, A.M.A. Arch. Ophth. 61:6633-640 (April)
1959. (b) Hanno, H. A., and Cleveland, A. F. Leptospiral
Uveitis, Am. J. Ophth. 32:1564-1566 (Nov.) 1949. (c)
Alexander, A., and others: Leptospiral Uveitis, A.M.A.
Arch. Ophth. 48:292-297 (Sept.) 1952. (d) Beeson, P B.,
Hankey, D. D., and Cooper, C. F., Jr.: Leptospiral Iri-
docyclitis; Evidence of Human Infection with Leptospira
Pomona in United States, J. A. M. A. 145:229-230 (Jan.
27) 1951. (e) Edwards, G. A.: Clinical Characteristics
of Leptospirosis, Am. J. Med. 27:4-17 (July) 1959.

7. Middleton, J. E.: Canicola Fever with Neurological Com-
plications, Brit. M. J. 2:25-26 (July 2) 1955.

8. Davidson, L. S. P., and Smith. J.: Weil's Disease in
Fish-Workers; A Clinical, Chemical and Bacteriological
Study of 40 Cases, Quart. J. Med. 5:263-286 (April) 1936.

9. Woodard, T. E. : The Protean Manifestations of Lepto-
spirosis. U. S. Army Medical Service Graduate School,
Symposium on the Leptospiroses, M. Science Publication
No. 1., U. S. Government Printing Office, Washington,
D. C, pp. 57-71, 1953.

.•542

Aim-list. 1960

Salmonella and Shigella Infections Found
In One Hundred Ninety-five Cases of Acute Diarrhea

E. R. Caldwell, Jr., M.D.

and

E. A. Abernathy, M.D.

Statesville

In October, 1952, it was decided that all
patients admitted to this small general hos-
pital with a chief complaint of diarrhea
would have a single stool culture prior to
the institution of any therapy. This culture
was taken from the first stol passed, and
therapy was then started. Blood cultures
were made in only a few selected patients in
whom the illness seemed more severe. Rou-
tine blood tests (hemoglobin determination,
red blood cell count, white blood cell count,
and erythrocyte sedimentation rate) and
urinalyses were carried out, but are not an-
alyzed in this report. The study was con-
ducted to determine the bacteriologic con-
tent of a single stool culture. It is realized
that in private practice one cannot pursue
as thorough a bacteriologic analysis as would
be possible in a teaching hospital ; however,
we believe that a single specimen collected
and mailed to the State Laboratory may be
quite revealing in determining the cause of
diarrhea in some cases.

Results
Table 1 shows that out of 195 cultures 23
pathogenic organisms were isolated — an in-
cidence of 11.8 per cent. Probably this fig-
ure would have been higher if repeated cul-
tures had been made. Twelve Salmonella and
11 Shigella organisms were isolated. One
case of Salmonella typhosa was discovered,
but was not included in this series because
no diarrhea was present. A diagnosis was
made seriologically and finally proven bac-
teriologically when a positive stool culture
was obtained after several attempts.

From Davis Hospital. Statesville. North Carolina.
We are indebted to the North Carolina State L iboratory of
Hygiene for the bacteriologic studies.

Table 1

I Salmone

Montevideo

Typhimurium

Derby

Enteritidis

Senftenberg

Javiana

II Shigella

Sonnei
Flexneri
Flexneri
Sonnei
Negative Cultures
Positive Cultures

Total Cultures

I

3
6

II

172
23

195

I Salmonella

Typhimurium

Montivideo

Derby

Enteritidis

Senftenberg

Javiana

Total

II Shigella

Sonnei
Sonnei
Flexneri
Flexneri

II
6
3

Total

12

5
1

4
1

II

Conclusions

Though trained bacteriologists are not
available in all hospitals and private office
laboratories, it is possible, by using avail-
able facilities, to isolate many pathogenic
organisms and so achieve a somewhat more
scientific approach to our practice. It is grat-
ifying to be able to make a definite diag-
nosis in some of the otherwise obscure types
of diarrhea.

Every human being has an innate dread of illness, and brings to his
doctor his fears, his hopes, and his confidence. Medical care is very def-
initely a personal service. Science is a requisite but without sympathy is
woefully inadequate. — Rouse, M.O. : Essential "Intangibles" in Medicine,
South. M. J. 53:1 (Jan.) 1960.

August, 1960

EDITORALS

343

North Carolina Medical Journal

Owned and published by

The Medical Society of the State of North Carolina,

under the direction of its Editorial Board.

EDITORIAL BOARD
Wingate M. Johnson, M.D., Winston-Salem

Editor
Miss Louise MacMillan, Winston-Salem

Assistant Editor
Mr. James T. Barnes, Raleigh

Business Manager
Ernest W. Furgurson, M.D., Plymouth
John Borden Graham, M.D., Chapel Hill
G. Westbrook Murphy, M.D., Asheville
William M. Nicholson, M.D., Durham
Robert W. Prichard, M.D., Winston-Salem
Charles W. Styron, M.D., Raleigh

Address manuscripts and communications regarding
editorial matter to the
NORTH CAROLINA MEDICAL JOURNAL
300 South Hawthorne Road, Winston-Salem 7, N. C.
Questions relating to subscription rates, advertis-
ing, ect., should be addressed to the Business
Manager, 203 Capital Club Building, Raleigh, N. C.
All advertisements are accepted subject to the ap-
proval of a screening committee of the State
Journal Advertising Bureau, 510 North Dearborn
Street, Chicago 10, Illinois, and/or by a Committee
of the Editorial Board of the North Carolina Medi-
cal Journal in respect to strictly local advertising
accepted for appearance in the North Carolina
Medical Journal.

Annual subscription, $5.00 Single copies, 75c1

Publication office: Carmichael Printing Co., 1309

Hawthorne Road, S.W., Winston-Salem 1, N. C.

August, 1960

NAMING NEW DRUGS

The rapid multiplication of new drugs is
creating a real problem for physicians,
medical students, and pharmacists. It is
well nigh impossible to memorize even the
names of the hundreds of new preparations
marketed every year — much less to learn
their indications, contraindication, side-ef-
fects, and dosage. The confusion is com-
pounded by the fact that every drug has at
least three names: chemical, generic, and
brand. The chemical names, while admit-
tedly more scientific, have a very limited
application for the average medical man.
Generic is used in the sense of Webster's
definition, "General ; opposed to specific."
The brand names are selected by the manu-
facturers and are copyrighted. As an ex-
treme example, there are more than 18
brand names for reserpine. If a doctor pre-
scribes a drug by its generic name, the
druggist is not obligated to use the product
of any one manufacturer. If, however, the
brand name is used, the druggist must use
the one specified.

The manufacturers seek to justify the
use of brand names as necessary to insure
that the drug meets the proper standards
in its preparation and that inferior pro-
ducts are not sold. The widespread use of
copyright brands, however, imposes a hard-
ship on the doctor, who has trouble enough
remembering simple generic names; on the
druggist, who must carry in stock many
forms of the generic drug ; and on the con-
sumer, who must pay more for the addition-
al expense entailed in marketing and adver-
tising the product.

The Advertising Committee of the New
England Journal of Medicine (vol. 263:1,
July 7, 1960) offers a most constructive so-
lution of this problem of naming new
drugs. A special article, "Drug Terminol-
ogy and the Urgent Need for Reform," con-
cludes with the following pertinent sugges-
tions:

The generic term must be selected and made
available for every new drug before it is put on
the market. This should be a requirement of the
Food and Drug Administration. Generic names
should be selected by a National Advisory Com-
mittee appointed by the Food and Drug Admin-
istration. This committee should consist of ex-
perts in medicine, pharmacy, psychology and
marketing. The terms must be brief and de-
signed with regard for their dignity, visual and
oral reception and mnemonic connotations. Cer-
tainly, such an expert committee could design
much better generic terminology than is at pre-
sent available.

Once the generic term is selected and adopted
it must represent the highest standards avail-
able for that product . . . Once this is done the
physician can be certain of the drug his patient
will receive.

The medical profession should engage in a
campaign to urge physicians to give generic
names prominence in all medical writing, adver-
tising and usage. Medical journal editors should
join in this campaign and see to it that generic
terminology is the terminology of choice in ad-
vertising.

A monthly glossary of generic names and the
standards that they represent should be pub-
lished in leading medical journals and perhaps
sent to physicians by the Food and Drug Ad-
ministration.

Finally, many medical authorities agree that
inclusion of the manufacturer's name after the
generic name would in the end give him equal
protection and even more favorable recognition
than the present undesirable trade-name prac-
tice. For the belief is growing that a manu-
facturer's reputation and good will are asso-
ciated rather with his company name than with

344

NORTH CAROLINA MEDICAL JOURNAL

August, 1960

fanciful copyrighted and generally inane neolog-
isms.

As Editor Joseph Garland comments in
the same issue:

If manufacturers will have only enough faith
in themselves to rely on their institutional re-
putation to assure the purchaser that their par-
ticular product is an especially reliable one, they
will almost certainly gain additional prestige
with the professional men and women whom
they are trying to impress.

With the scrupulous observance of such poli-
cies the management of drug therapy would be
even more solidly vested in the medical profes-
sion, where all would agree that it belongs. It
may be expected that the advertiser who ap-
peals to the intelligence of his professional clien-
tele will not lose by such a display by confidence.
It is devoutly to be wished that these
constructive suggestions of our New Eng-
land contemporary will be accepted.

chiatric service. The number had increased
to 200 by the end of World War II, in 1945,
and by 1957 there were 584. Many more
have let down their bars since then. In
some of these the psychiatric division is
closed, but in perhaps most of them it is
open, and patients may be given insulin and
electroshock therapy in their rooms.

Any doctor who has had to deal with
"borderline" cases, such as mental depres-
sion or anxiety states, can appreciate the
advantage of having such patients in a gen-
eral hospital. And as the Southern Medical
Journal editorial points out, the admission
of psychiatric patients to a general hospital
has educational and training value both for
the psychiatrist and for the house staff. It
will be gratifying to see the increasing use
of general hospital beds for mentally ill pa-
tients.

THE ARTHRITIS HOAX

The Public Affairs Committee, a nonprof-
it organization, in cooperation with the
Arthritis and Rheumatism Foundation, has
prepared a 20-page pamphlet, "The Arthri-
tis Hoax," which exposes the many ways
by which victims of arthritis are exploited
to the tune of more than 250 million dol-
lars a year by worse than useless drugs, de-
vices, and treatments, ranging from copper
bracelets to "uranium mines," and from
dietary fads to analgesic drugs. The pam-
phlet is sold for 20 cents by the Public Af-
fairs Committee— 22 East 38th Street, New
York 16. It gives the answers to many of
the questions that patients are apt to ask
the doctor, and is well worth the price.

PSYCHIATRIC PATIENTS IN
A GENERAL HOSPITAL

" 'Tis true, 'tis pity; and pity 'tis, 'tis
true" that there is a certain stigma at-
tached to being treated in a hospital de-
voted entirely to mentally ill patients. The
psychic trauma of such an experience may
intensify the patient's illness — especially in
mental depression, which is one of the most
frequent ailments for which doctors are
consulted. It is a cause for giving thanks
that so many general hospitals now admit
psychiatric patients.

An editorial in the July Southern Medical
Journal states that at the turn of the cen-
tury only 25 general hospitals had a psy-

THREE CORRECTIONS

Three mistakes were made in the June
issue editorial, One Hundredth Sixth An-
nual Session.

1. That the wrist watch presented Jim
Barnes was a gift from the Society. The
watch was given him by the past presidents
who have served with him since he became
our Executive Secretary, as a token of their
appreciation of his ability.

2. The statement that Billy Joe Patton
was Dr. Leonard Larson's son-in-law. Mrs.
Patton is a sister of Mr. John Collett of
Lenoir, and Mrs. Collett is Dr. Larson's
daughter. Although the editor's face is red,
he — and all other North Carolina doctors —
is glad to know that Dr. Larson, now Pres-
ident-elect of the American Medical Asso-
ciation, does have a daughter living in the
state, who will be a strong inducement for
him to visit us often.

3. The most serious error was a proof-
reading lapse. The statement that the mo-
tion to table the resolution from the Lenoir
Jones-Green Component Society to limit
the term of councilors "was defeated by a
vote of 55 to 48" should have read, "was
passed by a vote of 55 to 48."

Three boners in one editorial is a record
of which the editor is thoroughly ashamed
— and for which he has no one to blame but
himself. He can only promise to try to do
better in the future.

August, 1960

EDITORALS

345

DR. PRESTON— NEW EDITOR OF
HEALTH BULLETIN

In 1942 Dr. John H. Hamilton added to
his other duties as Assistant State Health
Director and Director of the State Labora-
tory of Hygiene the editorship of The
Health Bulletin. When the time came for
him to retire for chronologic reasons, the
very satisfactory way he has filled all three
positions was recognized in an appreciation
from the State Board of Health. This was
published in the May Health Bulletin to-
gether with his picture on the cover — with-
out his knowledge or consent. This same ap-
preciation appeared in the June issue of
the North Carolina Medical Journal.

The Board of Health was fortunate in
being able to fill Dr. Hamilton's place with-
out delay. Edwin S. Preston, M. A., LL. D.,
who has been selected to succeed Dr. Ham-
ilton is well qualified for the position. For
eight years he edited the Public Welfare
News, the official publication of the North
Carolina Board of Public Welfare. He was
also the Welfare Board's public relations
officer. In December, 1959, he came to the
State Board of Health as its public rela-
tions officer — so he is a "natural" for the
editorship of the Bulletin.

Dr. Preston is a graduate of the Univer-
sity of Tennessee and has an M. A. degree
from Mercer University. The honorary de-
gree of LL. D. was conferred by Baylor
University. This journal echoes the words
used by Dr. Roy Norton in the June Health
Bulletin, introducing him to the readers
of the Bulletin. Dr. Norton bespoke for Dr.
Preston "the same fine and helpful criti-
cism and assistance that has been given to
his predecessor by the friends who receive
The Health Bulletin."

"YOU ARE OLD, FATHER WILLIAM . ."*

Not so long ago, it seems, old people were
just old people, gentle, withering relics of
the past typified by Whistler's portrait of
his mother. True, they had their problems
then, but who hadn't? Some were incapa-
citated, other spry ; some were broke, others
solvent; some were happy, some sad.

Now our modern old people, more nu-
merous than before, thanks to modern doc-
tors, modern medical science, and modern

•Reprinted from the New York State Journal of Medicine.
May 15. 1960.

private enterprise in medicine, have been
metamorphosed. From being just old peo-
ple they have become recently desirable,
valuable political assets! Each has a genu-
ine exercisable franchise; some 15,000,000
potentially purchasable ballots ! Purchas-
able by inducement — not in cash but by
"benefits."

Both major political parties are offering
bids, the Democrats a Forand-type bill, the
Republicans a Javits-type bill. Suddenly the
health of the aged becomes the grave con-
cern of others besides the doctors.

Assuredly the old folks have not offered
their votes for sale; the most many ask for
is the privilege of continuing to work gain-
fully after sixty-five, not for a pittance but
according to their ability to earn and to pay
their taxes, employ their own doctors, and
buy their own insurance.

In all the election year turmoil over the
health of the old who hears any concern
expressed over the employers, the business
men, the small and large shop operators,
and others, men who create employment for
the young? In this election year and every
year, many thousands of young people will
for the first time have fastened about their
necks the yoke of withholding taxes, Social
Security taxes, rent, state, local taxes, union
dues, and the national debt. The young —
don't they enjoy the prospect of some forty-
seven years of work-filled and tax-ridden
pursuit of happiness?

The young people — will they not find it
increasingly difficult in this inflation-ridden
election year and those to follow to buy
bread for themselves and their children?
Who cares? Let them eat cake! They are
only the young. Will they find in their midst
anyone to arise and say in a loud voice to
politicians of both parties: Thou shalt not
press down upon the brow of youth a crown
of aging thorns!

NORTH CAROLINA'S COMMITTEE
ON MEDICAL CREDIT BUREAUS

The May issue of the A.M.A.'s PR Doc-
tor devotes more than two columns to a
very favorable discussion of the work done
by the Medical Credit Bureau Committee
of our State Society, of which Dr. Howard
Wilson of Raleigh is the chairman. Dr.
Wilson and his committee deserve much
credit for their fine work.

340

NORTH CAROLINA MEDICAL JOURNAL

August, 1900

Committees and Organizations

North Carolina Board of
Medical Examiners

THE BIENNIAL REGISTRATION ACT

The second registration of physicians in
North Carolina was completed in January,
1960. The registration went along smooth-
ly. The directory has been completed and
mailed to each physician. However, some
of our friends exercised their inalienable
right to register their objections to the reg-
istration. These, however, seemed to for-
get that this law was sponsored by the Med-
ical Society, under the directive of the
House of Delegates of 1956. The complain-
ant is usually concerned only with the fact
that he has to pay a fee and does not con-
sider what is best for the group as a whole.
It is a recognized principle of all people
who deal with licensure that registration is
necessary to keep the records and the office
running smoothly for the benefit of all phy-
sicians. Registration was not put into effect
as a revenue measure, but all the funds go
into the treasury of the Board and thereby
enable the Board to serve better the phy-
sicians and all citizens of the State of
North Carolina.

A native son recently returned to North
Carolina for practice. He had been away so
long he did not know of the registration.
When he registered, the office noted that an
official notice had been received from the
secretary of a board of medical examiners
of a distant state that this physician's li-
cense had been revoked, but sentence had
been suspended on conditions. The Board
has interviewed this physician. He has an
opportunity for rehabilitation under super-
vision.

The law as enacted was a compromise
draft to overcome the objections presented
to the Legislative Committee of the Med-
ical Society. The result has been that the
Board has been embarrassed on a number
of occasions by not having the power to
waive the penalty under conditions upon
which some people were late in registering.
The other professions and trades in North
Carolina controlled by a board have annual
registration. Their fees equal or are more
annually in the majority of the cases than
the fee which the physician pays every two
years.

The Board wishes to express its appre-
ciation to the leaders of the Medical Society
of the State of North Carolina, to the edi-
torial staff of our Journal, and to the
greater majority of the physicians of this
state who have accepted and co-operated
with this registration. It will be our aim to
continue to serve the citizens of our state
in our official capacity as a part of the state
government.

Joseph J. Combs, M.D., Secretary

North Carolina Board

of Medical Examiners

BULLETIN BOARD

COMING MEETINGS

State

North Carolina and South Carolina Eye, Ear,
Nose and Throat Societies' Annual Joint Meeting
— Hotel King: Cotton, Greensboro, September 11-14.

Fourth District Medical Society Meeting — Wil-
son, September 14.

North Carolina Urological Association, Annual
Meeting — Greystone Inn, Roaring- Gap, September
25-26.

North Carolina Fifth District Medical Society
Meeting — Mid Pines Club, Pinehurst, October 5.

North Carolina Society for Crippled Children
and Adults, Twenty-fifth Annual Meeting — Wash-
ington Duke Hotel, Durham, October 6-8.

A.M. A. Twentieth Annual Congress on Industrial
Health— Charlotte, October 10-12.

Duke University Medical Postgraduate Seminar
Cruise to the West Indies — November 9-18.

North Carolina Academy of General Practice,
Annual Meeting — Carolina Hotel, Pinehurst, No-
vember 27-30.

Regional and National

Fifth International Congress on Nutrition — ■
Sheraton Park and Shoreham Hotels, Washington,
D.C., September 1-7.

Southern Trudeau Society and Southern Tuber-
culosis Society Meeting — Hotel Francis Marion,
Charleston, South Carolina, September 14-16.

A.M. A. First Regional Conference on Rural
Health, Atlanta, Georgia, October 7-8.

American Rhinologic Society, Sixth Annual
Meeting — Belmont Hotel, Chicago, October 8.

American College of Surgeons, Forty-sixth An-
nual Clinical Congress — San Francisco, October
10-14.

Southeastern Allergy Association, Annual Meet-
ing— Atlanta Biltmore Hotel, Atlanta, Georgia,
October 21-22.

Southern Medical Association, Fifty-fourth An-
nual Meeting — Saint Louis, Missouri, October 31-
November 3.

Sixty-seventh Annual Convention of Military

August, 1960

BULLETIN BOARD

347

Surgeons — Washing-ton, D.C., October 31-Novem-
ber 2.

American Medical Writers' Association, Seven-
teenth Annual Meeting — Morrison Hotel, Chicago,
November 18-19.

Southeastern Region of the College of Ameri-
can Pathologists and the Virginia Society of
Pathologists, Seminar on Kidney Diseases — John
Marshall Hotel, Richmond, November 25-26.

New Members of the State Society

The following new physicians joined the Medical
Society of the State of North Carolina daring the
month of July.

Dr. Charles Bodine Neal, III, Duke University
School of Medicine, Durham; Dr. John William Or-
mand, Jr., 309 Lancaster Avenue, Monroe; Dr.
William Thomas Rice, 318 Mocksville Ave., Salis-
bury; Dr. Sigurd Carl Sandzen, McCain Sanator-
ium, McCain; Dr. Casper Carl Warren, Jr., 2016
Pershing St., Durham; Dr. Daniel Whitaker Davis,
1415 Ida Street, Durham; Dr. George Wesley Gen-
try, Jr., 607 S. Main St., Roxboro; Dr. Stuart Boat-
wright, Haywood County Hospital, Waynesville;
Dr. Joe Walton Frazer, Jr., 838 N. Elm St.,
Greensboro; Dr. Howard Scheyer Wainer, 1001 N.
Elm St., Greensboro; Dr. George Carl Alderman,
1019 Hawthorne Road, Wilmington.

News Notes from the University of
North Carolina School of Medicine

Several University of North Carolina School
faculty members are engaged in mid-summer work
in various parts of the world.

Dr. Hans H. Strupp, director of psychological
services in the School of Medicine, has been
awarded a grant from the National Institute of
Mental Health to organize a second conference on
research in psychotherapy to be held in Chapel
Hill next spring. The conference will be sponsored
by the American Psychological Association.

Dr. Carl E. Anderson, professor of biochemistry,
is serving as a visiting- scientist in the laboratory
of nutrition and endocrinology at the National In-
stitutes of Health in Bethesda, Maryland.

Dr. Colin G. Thomas, Jr., associate professor of
surgery, and Dr. Judson J. Van Wyk, associate
professor of pediatrics, are in London to partici-
pate in the fourth International Goiter Conference
meeting.

Dr. Ernest Craige, associate professor in the
Department of Medicine, has returned from South
America where he served as a visiting professor
in the Department of Internal Medicine at the
University of Del Valle in Cali, Colombia.

Leaving in August for Alexandria, Egypt, Dr.
Sidney S. Chipman, clinical professor of pediatrics,
will begin a one-year foreign teaching assignment
sponsored by the World Health Organization. He
will act as a visiting professor of social pediatrics
at the Higher Institute of Public Health.

A recent issue of a Swiss medical journal con-
tains an article by Dr. John A. Ewing, associate
professor of psychiatry at the University of North
Carolina School of Medicine.

The article, entitled "Nos malades et nos con-
tacts personnels avec eux," appears in Medecine
et Hygiene, which is printed in Geneva.

In his paper Dr. Ewing explains how the phy-
sician needs to learn to observe his feelings about
his patients. Some feelings may arise because of
factors within the doctor, or his patient may re-
mind him of someone else. Some patients frequent-
ly provoke special feelings in other people in al-
most all personal contacts.

If the physician is to control the relationship
and to use it for therapeutic purposes, he must
observe and identify his feelings about his patient,
Dr. Ewing- points out. The way the patient
"makes" the doctor feel about him can be seen as
similar to any symptom about which the patient
may complain. The physician needs to understand
this aspect of the patient as much as anything
else he finds in his examination, he said.

* * *

Dr. John K. Spitznagel of the University of
North Carolina School of Medicine recently gave
a seminar at the University of Florida in Gaines-
ville, Florida, where he spoke on "The Role of
Basic Proteins in Non-specific Resistence to In-
fection."

Dr. John H. Schwab, assistant professor of bac-
teriology of the University of North Carolina
School of Medicine, has gone to England to do a
year's research at the Lister Institute of Preven-
tive Medicine in London. He will work in the area
of natural resistence to infections.

* * *

A new brochure has been issued by the Univer-
sity of North Carolina Division of Health Affairs
which gives a thumbnail sketch of the various edu-
cational programs being offered by the University
Medical Center.

Designed primarily for high school and junior
colleg-e students, the illustrated brochure ranges
in content matter from the one-year training pro-
gram for dental assistants to the specialized pro-
grams for medical doctors.

Copies are available to students, educators and
other interested persons. They may be obtained by
writing to the U.N.C. Director of Admissions or
to the School of Medicine.

Ellen Anderson of the University of North Car-
olina School of Medicine was named president-
elect of the American Society of Medical Tech-
nologists at the annual convention of the organi-
zation in Atlantic City, New Jersey recently.

She will hold this office for one year and then
be installed as president of the professional society,
which has 8,000 members. The convention was at-
tended by 2,000 medical technologists.

:: is

NORTH CAROLINA MEDICAL JOURNAL

Aujrust. 1960

Since 1953 Miss Anderson has been chief cyto-
technologist in the Department of Pathology and
at the North Carolina Memorial Hospital.

* * :!=

Four faculty members of the section of Physical
Therapy of the University of North Carolina
School of Medicine attended the national confer-
ence of the American Physical Therapy Associa-
tion in Pittsburgh recently. They were Miss Mar-
garet Moore, head of the section; Miss Rachel
Nunley, Miss Mildred Wood, and Miss Enola Sue
Flowers.

Miss Moore addressed the Public Health Section
of the Conference on "Public Health in Physical
Therapy Education." She also attended a number
of sessions of the Council of Physical Therapy
School Directors, which also met in Pittsburgh
during- the association meeting.

Miss Wood is chairman of the Committee on
Graduate Study of the American Physical Therapy
Association and she reported on the activities of
the association in this field.

Dr. Charles E. Flowers of the Department of
Obstetrics and Gynecology addressed a meeting
of the Continental Gynecologic Society in Mon-
treal, Canada, on June 27-28. His topic was "Mag-
nesium Sulfate Therapy During Pregnancy."

Dr. Harrie R. Chamberlin of the Department of
Pediatrics spoke before a seminar at the West
Virginia University School of Medicine in Mor-
ganton, West Virginia on June 29-30. His topic-
was "Intrauterine Development and Environment."
The seminar is sponsored by the West Virginia
State Department of Health and the Children's
Bureau of the U. S. Department of Health, Educa-
tion and Welfare.

* * *

A new book entitled "Psychotherapists in Ac-
tion" has been published concerning the research
program being conducted by an associate professor
of psychology in the Department of Psychiatry at
the University of North Cai-olina School of Medi-
cine.

The work is by Dr. Hans H. Strupp, who also
is director of psychological services of North Car-
olina Memorial Hospital here at the University.
The publishers are Grune and Stratton of New
York.

This volume deals with how psychiatrists and
psychologists arrive at various conclusions and
judgments on the cases which they are treating
psychologically, and how they communicate with
their patients.

Dr. Strupp worked with some 200 psychothera-
pists in collecting- material for this book. Selected
reports from some 40 of these persons are con-
tained in this volume.

* * *

Dr. Carl W. Gottschalk, associate professor of
medicine, is transferring his research relating to
kidney functions from Chapel Hill to the Univer-

sity of Copenhagen, Denmark, for a period of one
year.

In Denmark, Dr. Gottschalk will be associated
with Dr. Hans Ussing of the Institute of Biolog-
ical Chemistry at the University of Copenhagen.
The year's program is co-sponsored by the Amer-
ican Heart Association and the U. S. Public Health
Service.

News Notes from the Bowman Gray
School of Medicine of
Wake Forest College

Dr. Donald M. Hayes, instructor in medicine,
has been appointed assistant dean of the Bowman
Gray School of Medicine. In his new work, Dr.
Hayes will be responsible for student admissions
and premedical relations. He will continue as a
full-time member of the Department of Internal
Medicine with active participation in teaching, and
research in hematology.

Dr. Hayes is a 1951 graduate of Wake Forest
College and received his medical degree from
Bowman Gray. He has taken postgraduate train-
ing in medicine at the Salt Lake County General
Hospital, Salt Lake City, Utah, and served as a
U. S. Public Health Service Fellow in Psychiatry
for one year at the Louisville General Hospital,
Louisville, Kentucky. In 1958 he completed his in-
ternal medicine residency at the North Carolina
Baptist Hospital.

For the past two years Dr. Hayes has served
as a hematologic fellow in medicine at Bowman
Gray, and for the past year has been instructor in

medicine.

* * *

A total of $19,440 has been received for five
cancer traineeships for young physicians in the
Departments of Medicine, Obstetrics-Gynecology,
Pathology, Radiology, and Surgery at the Bowman
Gray School of Medicine.

This training program has been established by
the National Cancer Institute in order to increase
the number of persons with broad medical exper-
ience and special orientation in cancer.

The recipients of the traineeships for this year
are: Drs. Edwin L. Auman, Department of Medi-
cine; J. Howard Young, Department of Obstetrics-
Gynecology; Robert S. Pool, Department of Pa-
thology; Samuel D. Pendergrass, Department of
Radiology; and Richard F. Bowling, Department
of Surgei-y.

Dr. Camillo Artom, professor of biochemistry,
and Dr. Hugh B. Lofland, assistant professor of
biochemistry, are the co-authors of a paper which
was presented at the Fifth Conference on the Bio-
chemical Problems of Lipids held in Marseilles,
France, July 21-23. The title of their paper is
"Incorporation of Ethanolamine and Phosphory-
lethanolamine into the Phospholipids of Liver
Preparations."

August, 1960

BULLETIN BOARD

349

Dr. Richard G. Kessel, instructor in anatomy,
has been awarded a postdoctoral fellowship by the
Division of General Medical Sciences of the U. S.
Public Health Service. These fellowships are
awarded to assist in the development of promising-
investigators in basic science fields. Dr. Kessel's
special research interest and training have been

in electron microscopy.

* * *

The U. S. Public Health Service has awarded a
grant of $19,665 to Dr. Robert P. Morehead, di-
rector of the Department of Pathology, and Dr.
J. H. Smith Foushee, assistant professor of
pathology. The official title of the grant is, "Com-
munity Cancer Demonstration Project Grant to
Train Cytotechnicians."

For some time now, the Bowman Gray School
of Medicine has supported the training of a lim-
ited number of student in exfoliative cytotechnol-
ogy, and this grant will permit expansion of the
training program and an increase in the number
of students.

News Notes from the Duke University
Medical Center

A pilot study aimed at helping persons disfig-
ured by injury or disease has been initiated at the
Duke University Medical Center.

The study is being conducted by the Center's
Department of Medical Art and Illustration with
financial support from the Office of Vocational Re-
habilitation, U. S. Department of Health, Educa-
tion and Welfare. Prof. Elon Clark is head of the
department.

Purpose of the project is to work toward the
production of better artificial noses, and other
parts of the face.

Research funds amounting to $39,900 have been
awarded to Duke University by the National
Science Foundation to support continuing investi-
gations of brain functions.

Dr. Talmadge L. Peele, associate professor of
anatomy in the Duke Medical Center, is pi-incipal
investigator for the project. Entitled "Interde-
pendence of Amygdala and Hypothalamus," the
research study is concerned with learning more
about the relationships between these two parts
of the brain.

F. Ross Porter, director of the Duke Medical
Center Foundation, has resigned to accept a posi-
tion as hospital advisor with the International Co-
operation Administration.

He will begin his first assignment in Bogota,
Colombia, early next year after several months of
orientation and other preparation. His duties will
be to work with the ICA and the Colombian gov-
ernment in developing a national pattern for im-
provement of hospital and health services in Co-
lombia.

A.M.A. INDUSTRIAL HEALTH CONGRESS
The Twentieth Annual Congress on Industrial
Health will be held in Charlotte, North Carolina,
October 10-12, under the sponsorship of the Coun-
cil on Occupational Health of the American Med-
ical Association.

The program will include discussions of occupa-
tional health in agriculture, mental and emotional
health in industry, problems in dermatitis in farm
and industry, and occupational health problems in
small employee groups.

Established in 1938, the council supports safe
and healthful working- conditions for employees
through medical supervision of workers, control of
environment, health education, and counseling, ac-
cording to B. Dixon Holland, M.D., council secre-
tary. The congress is sponsored each year by the
American Medical Assciation as a means of fur-
thering the development and maintenance of high
medical standards in industry and on the farm.

Approved for Category II credit for members of
the American Academy of General Practice, the
program is primarily directed toward the general
practitioner, whom, it is estimated, handles close
to 90 per cent of all the occupational medical
practice in the nation.

Presiding over the opening session of the con-
gress will be Dr. William P. Shepard of New York
City, chairman of the A.M.A. Council on Occupa-
tional Health. The meeting will begin at 2:00 p.m.
on Monday afternoon with Dr. Amos N. Johnson
of Garland, president of the Medical Society of the
State of North Carolina, as the first principal
speaker. The sessions continue through Wednesday
morning, including formal presentations by na-
tionally known speakers.

Cooperating sponsors include the Medical Society
of the State of North Carolina, the Governor's
Council on Occupational Health, the Mecklenburg
County Medical Society, and the Greater Charlotte
Occupational Health Council.

North Carolina Academy of
General Practice

The annual meeting of the North Carolina Acad-
emy of General Practice will be held at the Caro-
lina Hotel in Pinehurst, November 27-30.

The scientific sessions will be held daily from
9:00 a.m. to 12:30 p.m., leaving the afternoons free
for audiovisual presentations, golf, or relaxation
among friends.

Fourth District Medical Society

The Fourth District Medical Society will meet in
Wilson on September 14 at 6:30 p.m. Dr. Franklin
L. Angell of Roanoke, Virginia, will speak on the
subject "Premature Cranial Synostosis."

350

NORTH CAROLINA MEDICAL JOURNAL

August, 1960

Edgecombe-Nash Medical Society

The Edgecombe-Nash Medical Society met on
July 13 in Rocky Mount.

Dr. R. D. Komegay, program chairman for July,
presented Dr. James Ralph Dunn, Jr., who spoke
on the subject of vascular surgery.

News Notes

Dr. Robert E. Nolan has announced the opening
of his office at the O'Hanlon Building in Winston-
Salem. His practice will be limited to general
surgery.

Southeastern Allergy Association

The Southeastern Allergy Association will
hold its annual meeting at the Atlanta Biltmore
Hotel, Atlanta, Georgia, October 21 and 22, 1960.

Dr. Susan Dees, Duke Medical Center, Durham,
North Carolina is in charge of the program. Every-
one interested in allergy is invited to attend.

Southern Medical Association

A complete history of the 54-year old Southern
Medical Association comes off the press August
15.

Its author is C. P. Loranz, Birmingham, for
many years business manager and secretary-man-
ager of Southern Medical, now advisor and pro-
fessional relations counselor.

The history details the association's growth
from its beginning in 1906, and includes statistical
data on officers, places of meeting, research
awards and membership figures, in addition to
numerous photographs.

Georgia Warm Springs Foundation

Preliminary steps in a projected program to
convert the famed Georgia Warm Springs Founda-
tion into a general vocational rehabilitation center
serving the southeastern United States were an-
nounced recently.

With the decline in polio that has followed the
advent of the Salk vaccine five years ago, Warm
Springs has begun to utilize its vast rehabilitation
facilities to care for physical handicaps caused
by arthritis, birth defects, spinal cord lesions, cere-
bral vascular accidents, multiple sclerosis, and
other disabling neuromuscular disorders.

Seminar on Kidney Disease

The Southeastern Region of the College of
American Pathologists and the Virginia Society of
Pathologists will hold a joint meeting at the John
Marshall Hotel in Richmond, Virginia, on Novem-
ber 25 and 26, 1960, on kidney disease. The
speakers will include Drs. Stanley M. Kurtz, Peter
P. Ladewig, Henry D. Mcintosh, George Margolis,
Conrad L. Pirani, David E. Smith, and Max Wach-
stein. The slide seminar will be conducted by Drs.

Paul Kimmelstiel and Solomon Papper. The din-
ner speaker will be Dr. Frank C. Coleman, pres-
ident of the College of American Pathologists.

The slide sets for this seminar on kidney disease
may be purchased at a cost of $15.00 per set by
writing to: Dr. G. T. Mann, Professor of Forensic
Pathology, P. O. Box 41, Medical College of Vir-
ginia, Richmond 19, Virginia.

American Society for Clinical Nutrition

The formation of a new professional association,
the American Society for Clinical Nutrition, was
announced during the meetings of the American
Society for Clinical Investigation and the Amer-
ican Federation for Clinical Research in Atlantic
City recently. Arrangements are being made to
affiliate the A. S.C.N, with the American Institute
for Niu-ition.

Richard W. Vilter, M.D., professor of medicine
and chairman of the department, University of
Cincinnati, College of Medicine, was elected presi-
dent of the A. S.C.N, by the charter members at
the organization's first meeting.

A four-point list of objectives adopted at the
first meeting states that the A. S.C.N, shall:

1. Foster high standards for research on human
nutrition.

2. Promote undergraduate and graduate educa-
tion in human nutrition.

3. Provide a place and opportunity for research
workers on problems of human nutrition to
present and discuss their research activities
and results.

4. Provide a journal for the publication of mer-
itorious work on human nutrition.

The organizing group plans to adopt The Amer-
ican Journal of Clinical Nutrition as its official
publication. The journal is published by the Yorke
Group, a subsidiary of the Reuben H. Donnelley
Corporation.

AMERICAN RHINOLOGIC SOCIETY

The American Rhinologic Society will hold its
sixth annual meeting at the Belmont Hotel, Chi-
cago, October 8. Physicians are invited; there is
no registration fee.

The guest of honor and one of the afternoon
speakers will be Dr. Henry L. Williams of the
Mayo Clinic, Rochester, Minnesota, whose subject
will be "Thirty Years of Experience in Rhinology."
The dinner speaker will be Dr. Morris Fishbein,
Chicago, who will speak on "Fifty Years of Medical
Progress."

A two-day surgical seminar in the Illinois Ma-
sonic Hospital, Chicago, will immediately precede
the annual meeting.

For information, write Dr. Robert M. Hansen,
secretary, American Rhinologic Society, 1735
North Wheeler Avenue, Portland 17, Oregon.

August, 1960

BULLETIN BOARD

351

National Tuberculosis Association

A potential danger in the long-term use of ster-
oid hormones was dramatized in a special exhibit
prepared by the National Tuberculosis Association
for the one hundred ninth annual meeting of the
American Medical Association in Miami Beach.

On view before the A.M. A. members for the
first time, the exhibit, entitled "Steroids Activate
TB," reminded physicians that cortisone and re-
lated drugs can activate unsuspected latent tuber-
culosis.

The N.T.A. exhibit, winner of an. A.M. A. Honor-
able Mention award, was prepared under the di-
rection of Dr. Julius L. Wilson and Dr. Floyd M.
Feldmann of the American Thoracic Society
(N.T.A. Medical Section).

Fifth International Congress
on Nutrition

Nutrition scientists from all over the world will
participate in the Fifth International Congress on
Nutrition to be held in Washington, D. C, Sep-
tember 1-7, 1960. An all-day symposium on "World
Food Needs and Food Resources'' will be one of
the main features of the scientific program. The
remainder of the program will consist of seven
half-day panel discussions by invited participants,
and special sessions of 10-minute papers reporting
unpublished original research. Headquarter hotels
will be the Sheraton Park and Shoreham hotels.

American Urological Association

The American Urological Association offers an
annual award of $1,000 (first prize of $500, sec-
ond prize $300, and third prize $200) for essays
on the result of some clinical or laboratory re-
search in urology. Competition is limited to urolo-
gists who have been graduated not more than 10
years, and to hospital interns and residents doing
research work in urology.

The first prize essay will appear on the program
of the forthcoming meeting of the American Uro-
logical Association, to be held at the Hotel Bilt-
more, Los Angeles, California, May 22-25, 1961.

For full particulars write the Executive Secre-
tary, William P. Didusch, 1120 North Charles
Street, Baltimore, Maryland. Essays must be in
his hands before December 1, 1960.

World Congress of Psychiatry

The Third World Congress of Psychiatry, June
4-10, 1961, Montreal, Canada, is being held at the
invitation of McGill University and under the aus-
pices of the Canadian Psychiatric Association.
Meeting on the American Continent for the first
time, the Congress is expected to attract some
3,000 delegates from 62 nations. Representatives
will come from psychiatry and such allied fields
as general medical practice, psychology, biochem-
istry, nursing, sociology, anthropology, social work,
and pharmacology.

Copies of the Second Announcement, which carry
information regarding program and registration,
may be obtained by writing the General Secretary,
III World Congress of Psychiatry. 1025 Pine Ave-
nue West, Montreal 2, P.Q., Canada.

World Medical Association

The Secretary General of The World Medical
Association announced that Dr. Ernst Fromm,
treasurer of the Association, transmitted a check
for $1000 to the Secretary of the Colegio Medico de
Chile to be used to provide medical assistance re-
lief to the earthquake victims in Chile. Medical
associations and doctors of the world are urged to
provide medical supplies and funds for the relief
of these victims. Assistance should be addressed
to:

Dr. Rolando Castanon
Colegio Medico de Chile
Miraflores No. 464
Santiago, Chile

u. s. department of
Health, Education, and Welfare

Food and Drug Administration

Stronger regulations to insure that physicians
receive adequate information about the drugs they
prescribe and to insure the safety of new drugs
have been proposed by the Food and Drug Ad-
ministration.

The new regulations would:

(1) Require sweeping changes in the labeling of
prescription drugs. Virtually all prescription drug
packages and printed matter distributed to phy-
sicians to promote sale of a drug would be required
to bear complete information for professional use
of the drug, including information about any haz-
ards, side effects or necessary precautions. The
only exception in the proposed regulations would
apply to frequently used medicines that are com-
monly familiar to the doctor.

(2) Provide that when safety requires, a new
drug would be kept off the market until the man-
ufacturer's representations regarding the reliabil-
ity of manufacturing methods, facilities and con-
trols have been confirmed by a factory inspection
by the Food and Drug Administration.

Other proposed labeling changes would require
drugs for injection and for use in the eyes to bear
a quantitative declaration of all inactive ingredi-
ents. Labels of all prescription drugs would be re-
quired to include an "identifying lot or control
number from which it is possible to determine the
complete manufacturing history of the drug."

Commenting on the proposed regulations, George
P. Larrick, Commissioner of Food and Drugs, said:

"The large number of new medications has made
it increasingly difficult for doctors and pharmacists
to keep adequately informed about them. We are
hopeful that the proposed regulations will improve
the communication of vitally necessary informa-

352

NORTH CAROLINA MEDICAL JOURNAL

August, I960

tion and bring- about a general improvement in
drug promotion practices. At the same time, they
should furnish a basis for more effective govern-
ment control where necessary."

Interested persons are invited to submit written
comments on the proposed regulations to the
Hearing Clerk, Department of Health, Education
and Welfare, Room 5440, 330 Independence Ave.,
S.W., Washington 25, D. C , within 60 days from
the date of publication in the Federal Register.

Nursing homes throughout the Nation report a
wide range in daily operating costs, according to
a Public Health Service publication released re-
cently.

The booklet, "Costs of Operating Nursing
Homes and Related Facilities," cites costs from
36 studies in nursing homes, homes for the aged,
and boarding homes under proprietary, nonprofit,
and public auspices.

The report is available from the Superintendent
of Documents, U. S. Government Printing Office,
Washington 25, D. C, for 20 cents a copy.

Veterans Administration

Further progress in establishing the cause and
treatment of cardiac arrest (heart stoppage), a
dreaded complication of surgery, had been made

by doctors at the Brooklyn, New York, Veterans
Administration hospital.

A major factor, the research group feels, is
"potassium intoxication" induced by massive blood
transfusions.

If sudden heart stoppage occurs during surgery,
it is often a lethal complication even though
massage of the heart is instituted shortly after the
standstill occurs, according to Dr. Harry H. Le-
Veen of the Brooklyn VA hospital.

He and a team of research workers from this
hospital and the State University of New York
reported their findings in the June 18 issue of the
Journal of the American Medical Association.

Their attention was focused on blood transfu-
sions when they noticed that cardiac arrest oc-
curred in several patients following massive trans-
fusions.

A major new instrument for atomic medicine
has been installed at the Veterans Administration
center in Los Angeles, the VA announced recently.

Known as a human-body radiation counting
system, the 25-ton steel room, with instrumenta-
tion, makes possible measurement of the amount
of radiation present in the body from fallout, med-
ical dosage, handling radioactive materials, or
other sources.

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August, 1960

BULLETIN BOARD

353

Dr. William H. Blahd, chief of radioisotope
service at the center, said the counter will be used
in diagnosis and medical research and will be an
important resource for civil defense.

Red Cross Gives Safety Hints

Don't be a vital statistic this summer or fall.

This was the Red Cross warning to the millions
of Americans who will spend coming weekends
taking to the water.

A. W. Cantwell, National Director of Red Cross
Safety Services, gave these safety hints for
Americans interested in aquatics:

1. Learn to swim.

2. Make sure someone is near to help you if
you get in trouble.

3. Swim in a safe place.

4. Know the swimming area.

5. Don't go beyond safe limits or your ability.

6. Try to stay calm in case of trouble.

7. Keep safety equipment in your boat or canoe.
Non-swimmers should wear life vests when riding
in a small craft.

8. As a general rule stay with your boat or
canoe. Most small craft will float, even when filled
with water or overturned

9. Don't overload your boat.

10. Don't "overpower" your boat. A motor too
powerful for your boat makes it difficult to control.

Ten Rules for Cataract Patients

Ten rules for persons who have had cataracts
removed from their eyes are offered by a physician
who has undergone the surgery.

James M. Mackintosh, M.D., director of educa-
tion and training for the World Health Organ-
ization, Geneva, Switzerland, outlined them in
Hospitals, Journal of the American Hospital As-
sociation.

Dr. Mackintosh's rules are:

— Leave your glasses where you can find them
easily. This applies especially to the bedside at
night.

— Keep a spare pair of glasses in a well-marked
place known to wife, secretary, and self.

— On entering a room, survey the scene quickly
to detect hidden perils like footstools, low chairs,
small children lying on the floor, and other tripping
hazards near the ground.

— Look around the room to see who is there or you
may completely miss one of its inhabitants.

— Before getting up, make another quick survey
in case someone has placed a drink on a table below
your level of vision.

— -When walking and you meet someone you
know, turn your head rapidly from right to left to
make sure that he is not accompanied.

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354

NORTH CAROLINA MEDICAL JOURNAL

August. 1960

— In traffic always look several times to left
and right before crossing.

— Avoid occupations that require a great deal of
bending, such as gardening, automobile repairs,
and lifting heavy articles.

— Don't try to read too long at one time. A half-
hour spell, followed by a rest of 10 minutes, is
generally enough. The rest period must not be filled
with other eye-straining activities such as television
or sewing.

— Avoid contemplating rapidly moving objects,
such as movies or swiftly moving games, if this
gives a sense of strain.

Carbocaine Called Big
Advance In Anesthetics

A potent new local anesthetic, described as a
marked advance in its field following extensive
pharmacologic and clinical studies over the past
three years in the United States, Sweden, Den-
mark, Germany and other countries, has been
made available to the medical profession in this
country.

The new anesthetic agent is called Carbocaine,
and is a product of Winthrop Laboratories.

It has a number of advantages as a local anes-
thetic, chiefly its wide usefulness, high potency,
safety and suitability for use without epinephrine,
the vasoconstrictor.

Carbocaine has also been found to be extremely
stable, enabling solutions to be autoclaved re-
peatedly or stored for long periods without danger
of decomposition.

Classified Advertisements

X-RAY Equipment for sale or exchange. 100 K.V.
100 M.A. Picker Radiographic unit with manual
operated tilt table combined with Fluoroscope
unit beneath the table. Provides instant change
over from Fluoroscopy to Radiography with spot
film device. Has had some use but is in excellent
working order also dark room equipment, mag-
netic type plate changer, Stereoscopic view boxes,
etc., will consider late model Ultra-violet lamp,
surgical endotherm in exchange. Write Box 790,
Raleigh, North Carolina.

AVAILABLE Desirable twelve hundred and fifty
square feet space suitable for doctors or dentist.
Ground floor Cameron Court apartments, corner
Snow and Morgan Streets, Raleigh. Air con-
ditioned, also heat, lights, water and parking.
On long lease will improve to suit tenant. Apply
A. W. Criddle, Manager, Temple 2-5395.

DESIRABLE LOCATION for a physician. Contact
Godley Realty Company, Mt. Holly Road. Char-
lotte. North Carolina.

WANTED Otolaryngologist and or Ophthalmolo-
gist for extremely successful Asheville and
Western Carolina practice. Dr. Joseph McGowan
recently deceased. Fully equipped office, exper-
ienced personnel. Contact Mrs. Joseph McGowan,
303 Vanderbilt Road, Asheville, North Carolina.

BOOK REVIEWS

A Doctor in Many Lands. By Aldo Castel-

lani. 319 pages, plus 30 pages appendices.

Price, $4.95. Garden City, New York:

Doubleday and Company, 19(50.
Even in the antibiotic era most physicians have
heard of Castellani's mixture as a virtuous pre-
paration for fungal dermatoses, but fewer medical
men know much more about the contributions of
this extremely active man. Now over 80 years old,
Dr. Castellani has set down anecdotal reminis-
cences of a lively career on several continents.
Born and educated in Italy, he had further train-
ing in Germany, then went to England, casting his
fortunes with the Empire in Africa and Ceylon
until the 1914-1918 war. After service with the
Italian Navy, he spent some time in Poland, then
resumed practice and teaching in London, Rome
and New Orleans (at Tulane and Louisiana State.)
During those years he had a large clinical prac-
tice in addition to his laboratory work, he at-
tended many famous people, furnishing the back-
ground for amusing accounts about them. He was
very active with the Italian military during the
Ethiopian war. Still an Italian citizen, and this
time on the side opposite his British friends, Cas-
tellani again returned to Italy for the 1939-1945
war, seeing service in Europe and Africa. Follow-
ing the war he went into exile with the Italian
royal family and now lives in Portugal.

Castellani's autobiography does not really tell
a great deal about Castellani, dealing largely with
his environment and his patients. As an example,
he mentions his marriage, his wife, and daughter
in two paragraphs early in the book, and never
again. He is at some pains to make clear his con-
tributions in the discovery of the causative role
of trypanosomes in African sleeping sickness, and
various other original observations, and deals
briefly with the circumstances of their discovery.
One is impressed with the unflagging zeal and
curiosity he has brought to every task. Not satis-
fied with enjoying the golden beauty spots so
piized by Singhalese women he took some scrap-
ings from them and found they were fungus col-
onies!! Literary and poetic circles in Ceylon did
not receive this news enthusiastically, he remarks.
Castellani's remarks about Italian politicians,
royalty, and military men are especially interest-
ing. To the end, Castellani is a royalist, and his
praise of royalty is unbounded and unashamed.
Many of the famous Italians of this century have
been his patients, and from his long acquaintance
he draws many pages of remarks. Mussolini ap-
pears as a dedicated and capable man in his early
career, corrupted and ruined by the Germans. The
Ethiopian campaign is presented as a sort of an
armed cultural and economic mission, which was
largely beneficial to the Ethiopians. Castellani
feels that the success of the Italian campaign was
in large part due to adequate medical preparation
for a tropical war. He later discusses the adverse

August, 1960

BOOK REVIEWS

355

effect of the lack of adequate medical care in the
desert campaigns of the second World War. The
appendices deal with "Climate and Its Influence"
and "Medical Aspects of the Ethiopian Campaign."
The book is a pleasant day's reading for a sum-
mer vacation, and would make an excellent gift
for anyone interested in an urbane, gossipy, and
intelligent physician's account of a life well spent
and still in progress.

Rudolph Matas: A Biography of One of
the Great Pioneers in Surgery. By Isidore
Cohn, M. D., with Hermann B. Deutsch.
431 pages. Price, $5.95. Garden City, New
York: Doubleday & Company, Inc., 1960.

The subject of this biography provided a wealth
of material for the author, since Rudolph Matas
was not only one of the great surgeons of the
world, but also a prolific writer of medical articles
and one of the pioneers who crusaded to rid the
world of yellow fever.

The author has taken all the skeins of Dr.
Matas' life and woven them into a splendid and
enchanting story, one of the threads being the his-
tory of the conquest of Bronze John. Much of the
political history of New Orleans and Louisiana
during the ninety-seven years that Dr. Matas
lived is gathered together in this volume.

Dr. Cohn is to be congratulated on his ability to
bring out the true personality of this great sur-
geon and man. All students of medicine and per-
sons interested in history and the history of medi-
cine will be delighted to read this magnificent
story.

New Teaching Film Released by SK&F

"Resuscitation of the Newborn," the first in a
new series of Medical Teaching Films to be pro-
duced semi-annually by Smith Kline and French
Laboratories, was released to the medical pro-
fession recently.

Made under the medical direction of the Special
Committee on Infant Mortality of the Medical
Society of New York County, the color film illus-
trates essential techniques and principles for the
resuscitation of infants who do not breathe, or
whose breathing is impaired, at birth.

Two other educational films, produced before
the two-a-year program was begun, have been
incorporated into the SK&F Teaching Film Series.
They are "Recognition and Management of Re-
spiratory Acidosis," and "Human Gastric Func-
tion."

Prints of "Resuscitation of the Newborn," as
with the other two films in the new series, may
be obtained on free loan from Smith Kline and
French Professional Service and Hospital Repre-
sentatives, or directly from the Smith Kline and
French Medical Film Center, Philadelphia 1, Pa.

The Month in Washington

Congress returned to work this month to
take up its unfinished business, including
the controversial issue of health care for
the aged, in an atmosphere dominated by
election-year politics.

The three or four week, tag-end session
of Congress loomed as one of the most im-
portant meetings in the past decade as far
as possible impact on the medical profes-
sion is concerned.

The lawmakers are slated to decide
whether to embark the federal government
on a course that could threaten the private
practice of medicine, or to adopt a volun-
tary program that would pose no such dan-
ger.

The omnibus social security bill approved
by the House Ways and Means Committee
was easily cleared by the House, 381 to 23,
and sent to the Senate Finance Committee,
which held two days of hearings. The
measure contained a voluntary, federal-
state program for assisting needy aged
persons meet their health care costs. Both
the Administration and the American Med-
ical Association endorsed the House mea-
sure as in keeping with the concept of giv-
ing the states prime responsibility for
helping their citizens, for aiding those who
are most in need of help, and for avoiding
the compulsory aspects of health plans in-
volving the social security mechanism.

A vote by the Finance Committee, headed
by Senator Harry F. Byrd, (D., Va.) was
scheduled shortly after the Senate resumed
operations in August. Whatever action the
Committee took, however, proponents of
schemes such as the Forand bill to provide
a compulsory, federal medical program
promised a determined fight on the floor of
the Senate.

In the event Congress should approve a
government medicine plan, opponents were
counting on a Presidential veto to kill the
measure. The Chief Executive repeatedly
has asserted in strong language his all-out
opposition to any compulsory plan for
health care financing.

At the Senate Finance Committee hear-
ing, Arthur S. Flemming, Secretary of
Health, Education and Welfare, renewed
the Administration's flat stand against the
social security avenue to financing health

From the Washington Office of the American Medical As-
sociation.

356

NORTH CAROLINA MEDICAL JOURNAL

August, 1960

costs. Such a plan, he said, would inevit-
ably lead to pressures for expanding the
benefits and lowering or eliminating the
age requirement. Under such circumstances,
a 15 per cent or 20 per cent social security
payroll tax would not be too far off, he said.
"We believe it is unsound to assume that
revenue possibilities from a payroll tax are
limitless."

Dr. Leonard W. Larson, president-elect
of the American Medical Association, told
the Committee the House bill is the "anti-
thesis of the centralized, socialized, statist
approach of the proposals advocating na-
tional compulsory health insurance."

A spokesman for the insurance industry
pointed out "giant strides" made by private
health insurance in recent years in cover-
ing aged persons. E. J. Faulkner declared
that one of the most prevalent and erron-
eous assumptions on the matter is that
most of the aged aren't able to contribute
to financing their own health care costs.

The Social Security health bills, he said,
"would impair or destroy the private prac-
tice of medicine, would add immeasurably
to our already crushing tax burden, would
aggravate our severe public fiscal problems,
and would entail other undesirable conse-
quences."

In other testimony, the AFL-CIO again
urged enactment of a Social Security health
bill ; the American Optometric Association
and the International Chiropractors Asso-
ciation urged that health benefits included
in any bill include the services of osteo-
paths and chiropractors, respectively.

On another legislative proposal of in-
terest to the medical profession — the
Keogh-Simpson bill — a Senate debate was

scheduled this month. Senator Gordon Al-
lott (R., Colo.) said in a Senate speech
that "I believe that this legislation will
have the overwhelming support of this
body."

The bill, which would encourage retire-
ment savings by the self-employed such as
lawyers, small businessmen and physicians
has already been approved by the House.
The Senate bill, voted by the Senate Fi-
nance Committee, would require participat-
ing self-employed to establish retirement
plans for their employees.

Jin fiemmiam

Robert A. Matheson, M.D.

Dr. Robert A. Matheson was born in Hoke
County on January 12, 1898. He died at his home
in Raeford, on April 24, 1960.

He was graduated from the University of North
Carolina. After studying medicine there for two
years he enrolled at Jefferson Medical College
where he was graduated in 1926. He served his in-
ternship in Atlantic City, New Jersey, and was
chief resident physician there for one year. He
served in France during World War I and later
was a major in the North Carolina National Guard.
He was a member of the Raeford Methodist
Church, the Raeford Kiwanis Club, and was a
Shriner.

He was a member of the Hoke County Medical
Society, the Medical Society of the State of North
Carolina, and the Southern Medical Association.
He practiced medicine in Raeford from 1928 until
his death. He was a family doctor in every sense
of the word. He not only was friend, counselor and
guide to his many patients, but was also highly
esteemed by all his colleagues.

Winston-Salem •

• ••••□ a Greensboro

*• •• * •

• * •□ Raleigh

•• ••

gAsheville Washington.

MATERNAL DEATHS REPORTED IN NORTH CAROLINA
SINCE JANUARY I, I960

Each dot represents one death

August, 1960

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edema.

Aldactone inactivates a crucial mechanism producing and
maintaining edema — the effect of excessive activity of the
potent salt-retaining hormone, aldosterone. This corrective ac-
tion produces a satisfactory relief of edema even in conditions
wholly or partially refractory to other drugs.

Also, Aldactone acts in a different manner and at a different
site in the renal tubules than other drugs. This difference in
action permits a true synergism with mercurial and thiazide
diuretics, supplementing and potentiating their beneficial
effects.

Further, Aldactone minimizes the electrolyte upheaval often
caused by mercurial and thiazide compounds.

The accompanying graph shows a dramatic but by no means
unusual instance of the effect of Aldactone in refractory edema.

The usual adult dosage of Aldactone, brand of spironolactone,
is 400 rag. daily. Complete dosage information is contained in
Searle New Product Brochure No. 52.

SUPPLIED: Aldactone is supplied as compression-coated
yellow tablets of 100 mg.

G.D. SEARLE & CO., Chicago 80, Illinois.
Research in the Service of Medicine.

weight- lbs ffirs i S , Congestive Heart Failure

140-
130-
120-
110-

f

1

40

A

Or

da
ng

do

n

ne
4h

rs.

\

Vs.

«.

x

\

\

severe actdo

sis

aeetaioleamide
250 mg./O.O.D.

V

\

\

KCI 3gm./24h.s. [

i

ysine HCI 30 gm./24

rs.

NH.CI 6gm/24hrs. prednisone 10 mg/24 hrs.

hydrochlorothiazide 100 mg./24 hrs. *%+

maintained on digitalis

l iTl

1

Ng
1

1 J J III III ||

5 10 15 20 25 30 35 40 45 50 55 58

(Days on Tr eatment] 'patient discharged. weight normas

day':,

XXX

NORTH CAROLINA MEDICAL JOURNAL

August, 1960

August, 1960

ADVERTISEMENTS

XXXI

whenever digitalis
is indicated

— g

y

LANOXIN DIGOXIN

formerly known as Digoxin 'B. W. & Co. '"

Boston, U«"= ^^^^^^—

'LANOXIN' TABLETS 'LANOXIN' INJECTION

0.25 mg. scored (white) 0.5 mg. in 2 cc. (I.M. or I.V.)

0.5 mg. scored ( green )

'LANOXIN' ELIXIR PEDIATRIC
0.05 mg. in 1 cc.

BURROUGHS WELLCOME & CO. (U.S.A.) INC., Tuckahoe, N.Y.

XXXII

NORTH CAROLINA MEDICAL JOURNAL

August, 1960

WHEN
THE PATIE
WITHO
ORGANIC DISEASE
COMPLAINS

CONSIDER

L NEOCHOLAN'

Your patient will often respond promptly to Neocholan therapy. It greatly increases the flow of
thin, nonviscid bile and corrects biliary stasis by flushing the biliary system. It also relaxes intesti-
nal spasm, resulting in an unimpeded flow of bile and pancreatic juice into the small intestine.
Neocholan helps to promote proper digestion and absorption of nutrients. It also encourages
normal peristalsis by restoring intestinal tone.

Each tabletprovides: Dehydrocholic Acid Compound,
P-M Co. 265 mg. (Dehydrocholic Acid. 250 mg.);
Homatropine methylbromide 1.2 mg.; Phenobarbital
8.0 mg. Supplied in bottles of 100 tablets.

MM

PITMAN-MOORE COMPANY

DIVISION OF ALLIED LABORATORIES, INC.
INDIANAPOLIS, INDIANA

August, 1960

ADVERTISEMENTS

XXXIII

in all common diarrheas

POMALIN

LIQUID

AN T I D I AR R H EAL

with pleasant raspberry flavor

V *

— eases and speeds the return
to normal bowel function —

The comprehensive antidiarrheal formula of Pomalin brings positive relief to
patients with specific and nonspecific diarrheas, bacillary dysentery, non-
specific ulcerative colitis and enteric disturbances induced by antibiotics.

Pectin and kaolin protect against mechanical irritation, adsorb toxins and
bacteria, and consolidate fluid stools. Sulfaguanidine concentrates antibac-
terial action in the enteric tract. Opium tincture suppresses excessive peristalsis
and reduces the defecation reflex.

Each palatable IS cc. ftab/espoon/ contains:

Sulfaguanidine U.S. P. 2 Gm.

Pectin N.F. 0.225 Gm.

Kaolin 3 Gm.

Opium tincture U.S. P. 0.08 cc.

(equivalent to 2 cc. of paregoric)
Dosage

ADULTS: Initially 1 or 2 tablespoons
from four to six times daily, or 1 or 2
teaspoons after each loose bowel move-
ment; reduce dosage as diarrhea sub-
sides.

I lltiitmob

L LABORATORIES

New York 18, .

CHILDREN: Vi teaspoon (2.5 cc.) per 15
pounds of body weight every four hours
day and night until stools are reduced
to five daily, then every eight hours for
three days.

HOW SUPPLIED: Bottles of 16 fl. oz

Exempt narcotic.

Available on prescription only.

XXXIV

NORTH CAROLINA MEDICAL JOURNAL

August, I960

for more normal living
in angina pectoris

Brand of Penlaerythrltol Tetranitrate, 30 mg.

Antora-B

with 50 mg. Secobarbital

/

Reduces incidence and
Severity of attacks

Continuous release Antora cap-
sules give long, sustained therapeutic
effect that reduces the number and
severity of attacks, lowers nitro-glyc-
erin requirements.

With reduced fear of attack your pa-
tient Is encouraged to participate in
activities to his allowed capacity.

.:.. ? -

P^ed&Um

ANTORA or AISTORA-B

One continuous release capsule
before breakfast and one before
the evening meal provides 24-
hour prophylactic effect.

Available in bottles of 60 and
250 capsules.

Effects sftlaiion

without mvntal or

phi/sival shur down

• A low dosage of
Secobarbital is grad-
ually released with
Antora over a 10-12-
hour period to reduce
the anxiety complex.
Antora-B also minimizes
insomnia due to pain
and shortness of
breath on effort.

Mayrand m

e.

PHARMACEUTICALS

Greensboro, North Carolina

August, 1960

ADVERTISEMENTS

XXXV

-,;.

■ -.3-

'**££%?&

**

. ,

■ i

.

;

for dryness and itching, prickly heat and rash
intertrigo, insect bites, other summer skin discomforts

«M

in the

^bath

6

p=o

^(N?

SARDO acts promptly to help restore needed
natural oil and moisture' to dry, itchy skin, by
helping to re-establish the normal lipid-aque-
ous balance. Thus SARDO eases irritation,
soothes, softens, brings sustained comfort.

USED IN THE BATH, SARDO releases millions
of microfine water-dispersible globules* to pro-
vide an emollient suspension which enhances
your other therapy ... in prickly heat, intertrigo,

insect bites, skin dryness and itch of atopic der-
matitis, eczematoid dermatitis, senile pruritus,
soap dermatitis, etc.'

Patients appreciate pleasant, convenient, easy-
to-use SARDO. Non-sensitizing. Most economical.
Bottles of 4, 8 and 16 oz.

Write for Lompm and literature . . .

IjClT'ClBClU, ITIC. New York 22, New York
e 1959 'Patent Pending. T. M.

XXXVI

NORTH CAROLINA MEDICAL JOURNAL

August, 1960

Sterazolidin

brand of prednisone-phenylbutazone

Even in the more transient rheumatic
disorders, an anti-inflammatory effect
more potent than that provided by aspirin
is often desirable to hasten recovery
and get the patient back to work.
By combining the anti-inflammatory
action of prednisone and phenylbutazone,
Sterazolidin brings about exceptionally
rapid resolution of inflammation with relief
of symptoms and restoration of function.
Since Sterazolidin is effective in low
dosage, the possibility of significant
hypercortisonism, even in long-term
therapy, is substantially reduced.

Availability: Each Sterazolidin* capsule contains prednisone
1.25 mg.; Butatolidin®, brand of phenylbutazone, 50 mg.;
dried aluminum hydroxide gel 100 mg.; magnesium
trisilicate 150 mg.; and homatropine methylbromlde 1.25 mg.
Bottles of 100 capsules.

Geigy. Ardsley, New York

Geigy

August, 1960

ADVERTISEMENTS

XXXVII

Diagnostic

Quandaries

Colitis? Gall Bladder Disease?

Chronic Appendicitis?

Rheumatoid Arthritis ? Regional Enteritis ?

I DISEASE that is frequently
W A V overlooked in solving diag-
W tfk ^ nostic quandaries is amebiasis.
MH Its symptoms art' varied and
contradictory, and diagnosis is extremely
difficult. In one study, 56% of the cases
would have been overlooked if the routine
three stool specimens had been relied on.1

Another study found 96% of a group
of 150 patients with rheumatoid arthritis
were infected by E. histolytica. In 15 of
these subjects, nine stool specimens were
required to establish the diagnosis.2

Webster discovered amebic infection in
147 cases with prior diagnoses of spastic
colon, psychoneurosis, gall bladder dis-
ease, nervous indigestion, chronic appen-
dicitis, and other diseases. Duration of
symptoms varied from one week to over
30 years. In some cases, it took as many
as six stool specimens to establish the
diagnosis of amebiasis.3

Now treatment with Glarubin provides
a means of differential diagnosis in sus-
pected cases of amebiasis. Glarubin, a
crystalline glycoside obtained from the
fruit of Simarouba glauca, is a safe, effec-
tive amebicide. It contains no arsenic,
bismuth, or iodine. Its virtual freedom
from toxicity makes it practical to treat

suspected cases without undertaking dif-
ficult, and frequently undependable, stool
analyses. Marked improvement following
administration of Glarubin indicates path-
ologically significant amebic infection.

Glarubin is administered orally in tablet
form and does not require strict medical
supervision or hospitalization. Extensive
clinical trials prove it highly effective in
intestinal amebiasis.

*

Glarubin

TABLETS

specific for intestinal amebiasis

Supplied in bottles of 40 tablets, each
tablet containing 50 mg. of glaucarubin.

Write for descriptive literature, bibli-
ography, and dosage schedules.

1. Cook, J.E.. Briegs. G.W., and Hlndley, F.W.: Chronic Ame-
biasis and the Need for a Diagnostic Profile, Am. Pract. and Dig
ot Treat. 6:1S21 iDec, 1955).

2 Rinehart. R.E.. and Marcus. H.: Incidence of Amebiasis in
Healthy Individuals, Clinic Patients and Those with Rheumatoid
Arthritis. Northwest Med.. 54:70S tJuly. 1955).

3. "Webster. B.H.: Amebiasis, a Disease of Multiple Manifesta-
tions, Am. Pract. and Dig. or Treat. 9:S97 (June, 195S).

•U.S. Pat. Ne. 2,864,745

THES.E. |V|ASSENGILL COMPANY

NEW YORK

BRISTOL, TENNESSEE
KANSAS CITY

SAN FRANCISCO

XXXVIII

NORTH CAROLINA MEDICAL JOURNAL

August, I960

• increases bile
Dechotyl stimulates
the flow of bile —
a natural bowel
regulator

• improves motility

Dechotyl gently stimulates

intestinal peristalsis

• softens feces
""" Dechotyl expedites fluid
penetration into bowel contents

helps free your patient from both...
constipation and laxatives

DECHOTYL

TR ABLETS'

well tolerated... gentle transition to normal bowel function

O Recommended to help convert the patient — naturally and gradually -to healthy
bowel habits. Regimens of one week or more are suggested to assure mainte-
nance of normal rhythm and to avoid the repetition of either laxative abuse or
constipation.

Average adult dose: Two Trablets at bedtime as needed or as directed by a physician. ^^^^^"'
Action usually is gradual, and some patients may need 1 or 2 Trablets 3 or 4 times daily. AMES

COMPANY, INC

Contraindications: Biliary tract obstruction; acute hepatitis. £"■►""> ■ i"*«"«

J t Toronto 'Canada

Dechotyl Trablets provide 200 mg. Decholin,^ (dehydrocholic acid, Ames), 50 mg.
desoxycholic acid, and 50 mg. dioctyl sodium sulfosuccinate, in each trapezoid-shaped.
yellow Trablet. Bottles of 100.
•Ames t.m. for trapezoid-shaped tablet. e<ieo

August, 1960

ADVERTISEMENTS

XXXIX

How to be
Carefree
Without
Hardly
Trying • • •

It really takes a load off your mind. . .
to know that you are protected from
loss of income due to illness or accident!

"Dr. Carefree" has no 30-day
sick leave ... no Workmen's
Compensation . . . BUT he has a
modern emergency INCOME PROTEC-
TION PLAN with Mutual of Omaha.

When he is totally disabled by accident or sickness covered by this plan, this plan
will give him emergency income, free of Federal income tax, eliminating the night-
mare caused by a long disability.

Thousands of members of the Medical Profession are protected with Mutual of Oma-
ha's PROFESSIONAL MEN'S PLAN, especially designed to meet the needs of the
profession.

If you do not already own a Mutual of Omaha INCOME PROTECTION PLAN, get in
touch now with the nearest General Agent, listed below. You'll get full details, with-
out obligation.

Mutuah

OF OMAH

Largest Exclusive Health and Accident Company in the World.

G. A. RICHARDSON, General Agent
Winston-Salem, N. C.

J. A. MORAN, General Agent
Wilmington, N. C.

J. P. GILES, General Agent
Asheville, N. C.

XL

NORTH CAROLINA MEDICAL JOURNAL

August, 1960

1

•^mJ

no irritating crystals • uniform concentration in each drop
STERILE OPHTHALMIC SOLUTION

NEO HYDELTRASOL

2,000 TIMES MORE SOLUBLE THAN

"The solution of prednisolone has the

advantage over the suspension in that no

crystalline residue is left in the patient's

cul-de-sac or in his lashes .... The other

advantage is that the patient does not have to

shake the drops and is therefore sure of

receiving a consistent dosage in each drop."2

PREDNISOLONE 21 PHOSPHATE-NEOMYCIN SULEATE

PREDNISOLONE OR HYDROCORTISONE

1. Lippmann. 0 : Arch. Ophth. 57:339. March 1957.

2. Gordon, DM.: Am J. Ophth. 46:740, November 1958.
supplied: 0.5% Sterile Ophthalmic Solution NEO-
HYDELTRASOL (with neomycin sulfate) and 0.5% Sterile
Ophthalmic Solution HYDELTRASOL'. In 5 cc. and 2.5 cc
dropper vials. Also available as 0.25% Ophthalmic
Ointment NEO-HYDELTRASOL (with neomycin sulfate)
and 0.25% Ophthalmic Ointment HYDELTRASOL.
In 3.5 Gm. tubes.

HYDELTRASOL and NEO-HYDELTRASOL are trademarks of Merck S Co.. Inc.
WSW MERCK SHARP & DOHMf Division of Merck S Co. Inc Philadelphia 1, Pa.

August, 1960

ADVERTISEMENTS

XLI

For Your Personal Pension Plan

The special features of the New England Life
contract will serve you to advantage

Recently we have run ads in this Journal and pointed out the new privileges to be
available to you and other professional practitioners in the formation of individual
retirement programs. We described the flexible change of plan clause in our policies,
and the special techniques and contracts developed in connection with Corporate
Pension Plans, pointing out that those fearures and services could well be applicable
to you personally.

The experience and services of our Company and Agency are available to you in con-
nection with your personal life insurance and retirement programs, regardless of
and independent of the Smothers, Keogh-Simpson Legislation that may be passed.
Any retirement program you may now initiate through New England Life can be
adapted through such legislation as may be passed in the future.

Again we list below our Agency Associates whose knowledge and experience may
serve you well.

AGENCY ASSOCIATES

ASHEVILLE

Henry E. Colton, C.L.U.

CHARLOTTE

A. J. Beall
Richard Cowhig
Colbert L. Dings
T. Ed Thorsen, C.L.U.

DURHAM

R. Kennon Taylor, Jr., C.L.U.

GASTONIA

Hugh F. Bryant

GREENSBORO

J. Meredith Moore

HICKORY

O. Reid Lineberger

HIGH POINT

Walter M. Bullock
George P. Clark

RALEIGH

John Cates

Ryland Duke

Carlyle Morris

Reid S. Towler, C.L.U.

REIDSVILLE

James E. Everette

STATESVILLE

Tom White
WILMINGTON

Meares Harriss, L. L.U.
Alex Urquhart, C.L.U.

WILSON

B. B. Plyler, Jr., C.L.U.
WINSTON-SALEM

Kenneth W. Maust

ARCHIE CARROLL, C.L.U., GENERAL AGENT

NEW ENGLAND

C^fe/LIFE±f^fe

«HI COMPANY THAI PCHJN040 MUTUAb IU>I IN|U«*"CI >" A M I * i CA -

612 Wachovia Bank Building

Charlotte, N. C.

XLII

NORTH CAROLINA MEDICAL JOURNAL

August.

SAINT ALBANS

PSYCHIATRIC HOSPITAL

(A Non-Profit Organization)

Rad&ord, Virginia

James P.
Daniel D. Chiles, M. D.

Clinical Director
James K. Morrow, M. D.
Silas R. Beany, M. D.

STAFF

<ing, M. D., Director

William D. Keck, M. D.
Edward W. Gamble, III, M. D.
J. William Giesen, M. D.
Internist (Consultant)

Clinical Psychology: Don Phillips
Thomas C. Camp, Ph. D. Administrator
Artie L. Sturgeon, Ph. D.

AFFILIATED CLINICS
Bluefield Mental Health Center Beckley Mental Health Center

525 Bland St., Bluefield, W. Va. 109 E. Main Street, Beckley, W. Va.
David M. Wayne, M. D. W. E. Wilkinson, M. D.
Phone: DAvenport 5-9159 Phone: CLifford 3-8397
Charleston Mental Health Center Norton Mental Health Clinic

1119 Virginia St., E., Charleston, W. Va. Norton Community Hospital, Norton, Va.
B. B. Young, M. D. Pierce D. Nelson, M. D.
Phone: Dickens 6-7691 Phone: 218, Ext. 55 and 56

TUCKER HOSPITAL, Inc.

212 West Franklin Street
Richmond, Virginia

A private hospital for diagnosis and treatment of psychiatric and neurol-
ogical patients.
Hospital and out-patient services.

(Organic diseases of the nervous system, psychoneuroses, psychosomatic
disorders, mood disturbances, social adjustment problems, involutional
reactions and selective psychotic and alcoholic problems.)

Dk. James Asa Shield

Dr. Weir M. Tucker

Dr. George S. Fultz

Dr. Amelia G. Wood

August, 1960

ADVERTISEMENTS

XLIII

anorectic-ataractic

BAMA

meprobamate 400 mg.. with d-amphetamine sulfate 5 mg., Tablets

FOR THERAPY
. OF OVERWEIGHT PATIENTS

■ d-amphetamine depresses appetite and

elevates mood

. i

[."-•meprobamate eases tensions of dieting !

i (yet without overstimulation, insomnia or '

barbiturate hangover).

I

Dosage: One tablet one-half to one hour before each meal. |

A LOGICAL COMBINATION

APPETITE CONTROL

L. , ---

Patronize

Your

Advertisers

**/*¥$

AMERICA'S

AUTHENTIC

HEALTH MAGAZINE

a good buy in
public relations

. . . place

today's health

in your reception room

Give your order to a member of your local Medical
Auxiliary or mail it to the Chicago office.

SPECIAL

HALF-PRICE RATES FOR

PHYSICIANS,

MEDICAL STUDENTS. INTERNS

TODAY'S HEALTH

PUBLISHED MONTHLY BY THE
AMERICAN MEDICAL ASSOCIATION
535 NORTH DEARBORN • CHICAGO IO

Please enter □, or renew □, my subscription for the
period checked below :

STREET-
CITY

CREDIT WOMAN'S AUXILIARY OF

D4 YEARS ... sVp^ S4.00 Q 2 YEARS . . .Vsj2fO S2.SO
□ 3 YEARS. . . S^TSiO S3. 25 D 1 YEAR «SOO SI. SO

XLIV

NORTH CAROLINA MEDICAL JOURNAL

August, 19(30

HIGHLAND HOSPITAL, INC.

Founded In 1904

ASHEVILLE, NORTH CAROLINA

Affiliated with Duke University

A non-profit psychiatric institution, offering modern diagnostic and treatment procedures — insulin, electroshock, psy-
chotherapy, occupational and recreational therapy — for nervous and mental disorders.

The Hospital is located in a 75-acre park, amid the scenic beauties of the Smoky Mountain Range of Western North
Carolina, affording exceptional opportunity for physical and emotional rehabilitation.

The OUT-PATIENT CLINIC offers diagnostic service and therapeutic treatment for selected case desiring non-
resident care.

R. CHARMAN CARROLL, M.D. ROBERT L. CRAIG, M.D. JOHN D. PATTON, M.D.
Medical Director Associate Medical Director Clinical Director

Compliments of

WachtePs, Inc*

SURGICAL
SUPPLIES

65 Haywood Street
ASHEVILLE, North Carolina

P. O. Box 1716 Telephone 3-7616—3-7617

p

^logical
-combination
I for appetite
| suppression

s meprobamate plus

i d-amphetamine... suppresses

appetite.

elevates mood..
without

% reduces tension
t v -; insomnia, overstimulation
*~ Je or barbiturate hangover.

anorectic-ataractic
Dosage: One tablet one-half to one hour before each meal.

August, 1960

ADVERTISEMENTS

XLV

APPALACHIAN HALL

ESTABLISHED — 1916

ASHEVILLE

NORTH CAROLINA

An Institution for the diagnosis and treatment of Psychiatric and Neurological illnesses, rest, convalescence, drucr

and alcohol habituation.

Insulin Coma, Electroshock and Psychotherapy are employed. The Institution is equipped with complete laboratory

facilities including electroencephalography and X-ray.

Appalachian Hall is located in Asheville, North Carolina, a resort town, wnich justly claims an all around climate

for health and comfort. There are ample facilities for classification of patients, rooms single or en suite.

Wm. Ray Griffin, Jr., M.D.
Robert A. Griffin, M.D.

Mark A. Griffin, Sr., M.D.
Mark A. Griffin, Jr., M.D.

For rates and further information write APPALACHIAN HALL, ASHEVILLE, N. C.

BRAWNER'S SANITARIUM, INC,

(Established 1910)
2932 South Atlanta Road, Smyrna, Georgia

FOR THE TREATMENT OF PSYCHIATRIC ILLNESSES
AND PROBLEMS OF ADDICTION

MODERN FACI LITI ES

Approved by Central Inspection Board of American Psychiatric Association
and the Joint Committee on Accreditation

Jas. N. Brawner, Jr., M.D.
Medical Director

Phone H Em lock 5-4486

How to Turn a *5M Raise
into a ^1,000 Bonus

Wishing won't turn a $5 a week
raise into a $1,000 bonus, but it's
easy to do. If you take that $5
raise and put it into U. S. Savings
Bonds you can buy a $25.00 Bond
a month (cost $18.75) and have
money left over. If you keep buy-
ing one of these Bonds a month
for 40 months you'll have your

big bonus— Bonds worth $1,000
at maturity.

It's a pretty smart idea to save
a raise. It's money you didn't
have before and shouldn't miss.
But, whether you've just gotten a
raise, or not, why don't you ask
your employer to include you in
the Payroll Savings Plan?

Why U.S. Savings Bonds are such
good way to save.

• You can save automatically wi
the Payroll Savings Plan • Y<
now earn 3:!4'c interest to m
turity • You invest without ri
under U. S. Government guara
tee • Your money can't be lo
or stolen • You can get yo
money, with interest, anytime yi
want it • You save more thi
money; you help your Governme
pay for peace • You can bi
Bonds where you work or ban

EVEN IF YOUR

BONDS ARE

DESTROYED. YOUR

MONEY IS SAFE.

Your Bonds
are recorded
in your name
at the Treas-
ury. If any-
thing happens to them the Gov-
ernment replaces them free.

YOU SAVE MORE THAN MONEY. You help save
the things worth living for. Every Bond
dollar helps keep America strong to pre-
serve the peace.

Every Savings Bond you own — old
or new — earns ^ % more than ever
before when held to maturity.

You Save More
Than Money With
U.S. Savings Bonds

WHAT SHOULD HE DO WITH AN EXTRA S5 A WEEK? He can spend it, of
course. But, if he buys a $25.00 U. S. Savings Bond each
month for 40 months with his $5 a week raise, he is going
to have Bonds worth $1,000.

The U. S, Government does not pay for this
advertising. The Treasury Department thanks
The Advertising Council and this magazine
for their patriotic donation.

August, 1960

ADVERTISEMENTS

XLVII

r 1

A !

logical

prescription for

overweight patients

anorectic-ataractic

■ m m m I

j meprobamate 400 mg., with d-amphetamine sulfate 5 mg., Tablets
i

meprobamate plus d-amphetamine...
depresses appetite... elevates mood...
eases tensions ot dieting. ..without over-
stimulation, insomnia or barbiturate

hangover.
\

Dosage: One tablet one-half to one hour before each meal.

Come to Mr. Pisgah and be tranquillized
by nature. Rustic inn & cottages perched
high on slope in National Forest near
Asheville. Heavenly quiet. Cool. Over-
looks glorious Great South View. Exhil-
arating air, superb food. Refuge and
restorative for tired doctors. May 1-Oct.
31.

Write

PISGAH FOREST INN

Candler, N. C. Rr. 1, Box 433

Posture

is A PLUS

YOU CAN GET FROM SLEEPING...
THAT'S WHY IT'S WISE TO SLEEP ON A

Sealq

POSTUREPEDIC

Uniformly firm,
Sealy Posturepedic
keeps the spine
level. Healthfully
comfortable, it per-
mits proper relaxa-
tion of musculatory
system and limbs.
Exclusive "live-ac-
tion" coils support
curved, fleshy con-
tours of the body,
assuring relaxing
rest that you know
is basic to good
health . . . and good
posture.

A Sagging
Mattress Can
Cause This)

PROFESSIONAL

DISCOUNT
OF

$39

00

Limit of one full or
two twin size sets

Please check preference

So that you as a physician can
judge the distinctive features of the
Sealy Posturepedic mattress for
yourself before you recommend it
to your patients, Sealy offers a spe-
cial Doctor's Discount on this mat-
tress and foundation, when pur-
chased for your personal use.

SEALY MATTRESS COMPANY

666 Lake Shore Drive, Chicago 1 1 , Illinois
RETAIL
Posturepedic Mattress each $79.50

Posturepedic Foundation each $79.50

TTull size ( ) 1 Twin size ( ) 2
Enclosed is my check and letterhead.
Please send my Sealy Posturepedic Set(s) to.

PROFESSIONAL

add5ratel $°0.00
,ax ( $60.00

Twin size { )

ADDRESS.

~ity

_ZONE_

XLVIII

NORTH CAROLINA MEDICAL JOURNAL

August, I960

miialis

in its completeness

irarroi'
Digitalis

I D* v \r a Ren- I

O.l Gram

aipiox. I1-. 8r»inst
CAUTIQKi FvdereJ
law prohibit* dispens-
ing without pr«**(*rip-
tion

Each pill is

equivalent to

one USP Digitalis Unit

Physiologically Standardized

therefore always

dependable.

Clinical samples sent to
physicians upon request.

Da vies, Rose & Co., Ltd.
Boston, 18, Mass.

*! Convalescence

a

Adolescence

Infant diarrhe^

Debilitating

gastrointestinal

conditio!

Old age

Whenever
the diet is faulty,
the appetite poor,
or the loss of food
is excessive

through vomiting
or diarrhea —

Valentine's

MEAT EXTRACT

stimulates the appetite,

increases the flow of
digestive juices,

provides: supplementary
amounts of vitamins, minerals
and soluble proteins,

extra-dietary vitamin Bu,

protective quantities of
potassium, in a palatable and
readily assimilated form.

• Postoperatively

Supplied in bottles oj 2 or 6 jluidounces.

Dosage is 1 teaspoonjul two or three times
daily; two or three times this amount for
potassium therapy.

VALENTINE Company, Inc.

RICHMOND 21, VIRGINIA

August, 1960

ADVERTISEMENTS

MUX

Westbrook. Sanatorium ]— ,

RICHMOND

€stablisheJ iQlL

VIRGINIA

A. private psychiatric hospital em-
ploying modern diagnostic and treat-
ment procedures — electro shock, in-
sulin, psychotherapy, occupational
and recreational therapy — for nervous
and mental disorders and problems of
addiction.

Staff Pu '- v- ANDERSON, M.D., President

REX BLANKINSHIP, M.D., Medical Director

JOHN R. SAUNDERS, M.D., Assistant
Medical Director

THOMAS F. COATES, M.D., Associate

JAMES K. HALL, JR., M.D., Associate

CHARLES A. PEACHEE, JR., M.S., Clinical
Psychologist

R. H. CRYTZER, Administrator

Brochure of Literature and Views Sent On Request - P. O. Box 1514 • Phone 5-3245

Protection Against Loss of Income
from Accident & Sickness as Well as
Hospital Expense Benefits for You and
All Your Eligible Dependents

All

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PHYSICIANS
SURGEONS
DENTISTS

All

BENEFITS

GO TO

PHYSICIANS CASUALTY & HEALTH
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OMAHA 31, NEBRASKA
Since 1902

Jandsome Professional Appointment Book sent to
yon FREE upon request.

F " • ■ :

i A LOGICAL ADJUNCT TO THE |
WEIGHT-REDUCING REGIMEN

meprobamate plus d-amphetamine . . .

reduces appetite. ..elevates mood. ..eases

tensions of dieting,.. without overstimula- j

i tion, insomnia or barbiturate hangover.
I I

Dosage: One tablet one-half to one hour before each meal. .

anorectic-ataractic

NORTH CAROLINA MEDICAL JOURNAL

August, 1960

THIS

Doctor

IS the SYMBOL 0F ASSURANCE OF ETHICAL
public relations minded handling of your accounts
receivable and collection problems.

IS ,he EMBLEM of sound experience in SERVICE
to the professional offices.

IS ,he MARK of a complete PROFESSIONAL
accounts receivable service.

Here Are the BUREAUS in Your Area Capable and Ready to Serve You

MEDICAL-DENTAL CREDIT BUREAU
514 Nissen Building
P. O. Box 3136
Winston-Salem, N. C.
Phone PArk 4-8373

MEDICAL-DENTAL CREDIT BUREAU
715 Odd Fellows Building
Raleigh, N. C.
Phone TEmple 2-2066

MEDICAL-DENTAL CREDIT BUREAU
513 Security Bank Building
High Point, N. C.
Phone 3955

MEDICAL-DENTAL CREDIT BUREAU
A division of Carolina Business Services
Room 10 Masonic Temple Building
P. O. Box 924
Wilmington, N. C.
Phone ROger 3-5191

MEDICAL-DENTAL CREDIT BUREAU
212 West Gaston Street
Greensboro, N. C.
Phone BRoadway 3-8255

MEDICAL-DENTAL CREDIT BUREAU
220 East 5th Street
Lumberton, N. C.
Phone REdfield 9-3283

MEDICAL-DENTAL CREDIT BUREAU,

225 Hawthorne Lane

Hawthorne Medical Center

Charlotte, N. C.

Phone FRanklin 7-1527

THE MEDICAL-DENTAL CREDIT BUREAU
Westgate Regional Shopping Center
Post Office Box 2868
Asheville, North Carolina
Phone ALpine 3-7378

INC.

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For Prevention and Reversal of

Cardiac Arrest

The Birtcher Mobile Cardiac Monitoring and Re-
suscitation Center*
\

Cardiac Arrest is an ever present danger during
anesthesia

Cardiac arrest can occur during an anesthesia, even to
patients with no prior record of cardiac disease. Contin-
uous monitoring of every patient can prevent most
cardiac arrests by providing advance warning. For cases
where the accident cannot be prevented, instruments to
reverse the arrest and restore circulation should always
be instantly available.

'Comprised of the Birtcher Cardioscope, EEG Pre-Amplifier, Dual
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Carolina Surgical Supply Company

r m "The House of Friendly and Dependable Service"

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August, 1960

ADVERTISEMENTS

LI

INDEX TO ADVERTISERS

American Casualty Insurance Company XIX

Ames Company XXXVIII

Appalachian Hall XLV

Arnar-Stone Laboratories XIII

Brawner's Sanitarium XLV

Brayten Pharmaceutical Company XV

Bristol Laboratories XVIII, XXI

Burroughs-Wellcome & Company XXXI

Carolina Surgical Supply Co L

Columbus Pharmacal Company XXX

J. L. Crumpton XXVIII

Davies, Rose & Co XLVIII

Geigy Pharmaceutical XXXVI

Highland Hospital XLIV

Hospital Saving Assn. of N. C XXV

Jones and Vaughan, Inc Ill

Lederle Laboratories XXVI, XXVII, XLIII,

XLIV, XLVII, XLIX
Eli Lilly & Company XXVII, Front Cover

The S. E. Massengill Company XXXVII

Mayrand, Inc XXXIV

Medical-Dental Credit Bureau L

Merck, Sharp & Dohme Second Cover, XL

Mutual of Omaha XXXIX

New England Mutual Life Insurance Co XLI

Parke, Davis & Co LII, Third Cover

Physicians Casualty Association

Physicians Health Association XLIX

Physicians Products Company XII

Pinebluff Sanitarium I

Pisgah Forest Inn XLVII

Pitman-Moore Company XXXII

P. Lorillard Company (Kent Cigarettes) XI

A. H. Robins Company X, XXIII

J. B. Roerig & Company XXII

Saint Albans Sanatorium XLII

Sardeau, Inc XXXV

W. B. Saunders Company VII

Sealy of the Carolinas, Inc XLVII

G. D. Searle & Co XXIX

Smith-Kline & French Laboratories 4th Cover

E. R. Squibbs and Sons XIV, XX

St. Paul Fire and Marine Insurance LI

Tucker Hospital XLII

U. S. Vitamin Company Reading-
Valentine Company XLVIII

Wachtel's Incorporated XLIV

Wallace Laboratories XVI, Insert, XVII

Wesson Oil and Snowdrift

Sales Company IV, V

Westbrook Sanitorrum XLIX

Winchester Surgical Supply Co.

Winchester-Riteh Co I

Winthrop Laboratories VI, Insert, IX, XXXIII

•Ury

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SOCIETY OF THE STATE OF
NORTH CAROLINA FOR
PROFESSIONAL
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THERE IS A SAINT PAUL AGENT IN YOUR
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Head Office
412 Addison Building
Charlotte, North Carolina
EDison 2-1633

HOME OFFICE: 385 WASHINGTON ST., ST. PAUL, MINN.

SERVICE OFFICE: RALEIGH, NORTH CAROLINA— 323 W. MORGAN ST. TEmple 4-7458

allergen in the wind

when pollens harry the unwary

antihistaminic-antispasmodic

gives prompt, comprehensive relief

In hay fever, BENADRYL provides simultaneous,
dual control of allergic symptoms. Nasal congestion,
lacrimation, sneezing, and related histamine reac-
tions are effectively relieved by the antihistaminic
action of BENADRYL. At the same time, its anti-
spasmodic effect alleviates bronchial and gastro-
intestinal spasms. This duality of action makes
BENADRYL valuable throughout a wide range of
allergic disorders.

BENADRYL Hydrochloride (diphenhydramine hydrochloride,
Parke-Davis) is available in a variety of forms including: Kap-
seals,®' 50 mg. each; Kapseals, 50 mg„ with ephedrine sulfate,
25 mg.; Capsules, 25 mg. each; Elixir, 10 mg. per 4 cc.; and for
delayed action, Emplets,® 50 mg. each. For parenteral therapy,
Benadryl Hydrochloride Steri-Vials,® 10 mg. per cc; and Am-
poules, 50 mg. per cc.

PARKE-DAVIS

PARKE, DAVIS & COMPANY- DETROIT 32, MICHIGAN

in overweight

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lethargic, depressed by reducing regimens:

R DEXEDRINE* SPANSULE®

brand of dextro amphetamine brand ot sustained release capsules

sulfate

Each 'Dexamyl' Spansule sustained release capsule (No. 2) contains 'Dexedrlne' (brand of
dextro amphetamine sulfate), 15 mg., and amobarbital, 1VS gr. Each 'Dexamyl' Spansule cap-
sule (No. 1) contains 'Dexedrine', 10 mg., and amobarbital, 1 gr.

Each 'Dexedrine' Spansule sustained release capsule contains dextro amphetamine sulfate,
5 mg., 10 mg., or 15 mg.

NORTH CAROLINA

RECEIVED

OCCUPATIONAL HEALTH ISSUE ,on

OCT 3 60

Congress on Industrial Health — Charlotte, October 10-12

DIVISION OF

Jcc&iRS LIBRARY-
HEALTH AFFAIRS lid

.;

when judgment dictates oral penicillin, experience dictates.

V-CILLIN K

(penicillin V potassium, Lilly)

' for maximum effectiveness
for unmatched speed
for unsurpassed safety

In tablets of 125 and 250 mg.

ELI LILLY AND COMPANY • INDIANAPOLIS 6, INDIANA, U.S.A.

®

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033230

Table of Contents, Page II

LINICAL REMISSION

I A "PROBLEM" ARTHRITIC

heumatoid arthritis with jerious_corticoid side effects. Follow.ng
ound weight loss and acute g.i. distress on prednisolone, a 45-year-
bookkeeper with a five-year history of severe arthritis was started
)ecadron, 1 mg./day. Dosage was promptly reduced to 0.5 mg./day.
,r ten months on Decadron, she gained back eleven pounds, feels
1 well, and had no recurrence of stomach symptoms. She is in
ical remission.*

convenient b.i.d. aUernate dosage schedule: ,he degree and extent of relief provided b»
IDRON atiows tor b.i.d. maintenance dosage in man, patients with so-called chrome .cor , ,-
, Acute manifestations sbou.d first be brought under contro! w,th a t.,.d. or q.i.d. schedule,
rttod- As 0 75 mg. and 0.5 mg. scored, pentagon-shaped tablets in bottles of 100. Also available
Action DECADRON Phosphate. Addition, information on DECADRON is available t. phys.c.ans
equest. DECADRON is a trademark of Merck & Co.. Inc.
„ a clinical investigator's report to Merck Sharp & Dohme.

lecadron

REflfS MORE PATIENTS MORE EFFECTIVELY

TM MERCK SHARP & DOHME • Division of Merck & Co., Inc., West Point, Pa.

September, 1960

ADVERTISEMENTS

A Sanitarium for Rest Under Medical Supervision, and Treatment of Nervous
and Mental Diseases, Alcoholism and Drug Addiction.

The Pineulutf sanitarium is situated in the sandhills of North Carolina in a 60-acre park
uf long pines. It is located on U. S. Route 1, six miles south of Pinehurst and Southern
Pines. This section is unexcelled for its healthful climate.

Ample facilities are afforded for recreational and occupational therapy, particularly out-
of-doors.

special stress is laid on psychotherapy. An effort is made to help the patient arrive at
an understanding of his problems and by adjustment to his personality difficulties or
modification of personality traits to effect a cure or improvement in the disease. Two resident
physicians and a limited number of patients afford individual treatment in each case.

Kor further information write:

The Pineblu££ Sanitarium, PinebiuSS, N. c.

iMalcolm D. Kemp, M.D.

Medical Director

ITTER*** the finest for

the profession!

Just a FEW of the Outstanding Features

THE RITTER UNIVERSAL TABLE enables
you to treat more patients more thoroughly,
with less effort in less time. Here is the ulti-
mate in examining table flexibility . . . easy
to position . . . more comfortable for patients.

• Grey vinyl upholstery, fabric backed.

• Perineal cut-out and stainless irrigating pan.

• Retractable, adjustable heel stirrups.

• Combination proctologic kneerest, footrest and
table extention.

• Maximum Trendelenburg 42°, Maximum
Reverse Trendelenburg 15°.

• Full 18" elevation from low of 26' 2" to high

of 44 y2".

• Effortless hand wheel tilt.

• Motor base has foot pedal elevating and lowering
controls accesible from either side of table.

0 Silver metallic finish

• Base permits 180° table rotation; foot lever rotation
lock.

• Stationary base plate, black enamel finish.

Authorized agents for, RITTER, LIEBEL-FLARSHEIM and CASTLE

WINCHESTER

"CAHOLINAS' HOUSE OF SERVICE"

WINCHESTER SURGIICAL SUPPLY CO. WINCHESTER-RITCH SURGICAL CO.

421 West Smith St. Greensboro, N. C.

119 East 7th Street

Charlotte, N. C.

II

NORTH CAROLINA MEDICAL JOURNAL

September. I960

North Carolina Medical Journal

Official Organ of
The Medical Society of the State of North Carolina

Volume 21

Number 9

September, 1960

76 CENTS A COPY
$6.00 A YEAR

CONTENT

Original Articles

Meeting- North Carolina's Occupational Health
Needs Through Our State Agencies — Emil
T. Chamblett 357

Economic Influences of an Industrial Medical
Program on a Countv Society — Mac Ray
Gasque, M.D., and Carl S. Plumb, M.D. . . 361

Compensable Occupational Diseases Under the
North Carolina Workmen's Compensation
Act— J. W. Bean 365

Radiation Hazards in Industry — Thomas S.
Ely, M.D 367

Physical Requirements in Textile Manufac-
turing— Charles G. Gunn, Jr., M.D. . . . 371

The Governor's Council on Occupational
Health: A Medium of Cooperative Effort
for the Health of the Worker — William
P. Richardson, M.D 377

Clinical Evaluation of the Antacid Properties
of Hydrated Magnesium Aluminate — David
Cayer, M.D., and M. Frank Sohmer, M.D. . 380

Mail Order Prescription Services — H. C. Mc-
Allister 382

Editorials

The National Election 385

Sabin Live-Virus Polio Vaccine Approved . . 386

Occupational Health Issue 387

The Speeding Ambulance 387

Mail Order Prescriptions 388

Bulletin Board

Coming Meetings 389

New Members of the State Society .... 390

News Notes from the Bowman Gray School
of Medicine 391

News Notes from the Duke University Med-
ical Center "... 391

News Notes from the University of North

Carolina School of Medicine 391

Winston-Salem Heart Symposium 392

North Carolina Board of Medical Examiners . 393

County Societies 393

News Notes 393

Announcements 394

Book Reviews

399

In Memoriam

401

Auxiliary

Transactions of the Thirty-seventh Annual
Session 403

Roster of Members, 1959-1960 413

Classified Advertisements

400

President's Message

388

Index to Advertisers
lxxi

Entered as second-class matter January 2. 1940, at the Post Office at Winston-Salem. North Carolina, under the Act of
August 24, 1912. Copyright 1960 by the Medical Society of the Stat* of North Carolina.

if?

®

SYRUP OF CHLORAL HYDRATE

NEW RALDRATE NOW SOLVES THE PROBLEM
OF TASTE RESISTANCE TO CHLORAL-HYDRATE

10 Grains (U.S. P. Dose) of palatable lime flavored
chloral-hydrate syrup in each teaspoonful

RAPID SEDATION WITHOUT HANGOVER

JONES and VAUGHAN, Inc. Richmond 26

, VA.

/w#r

clinically proven efficacy

in relieving tension . . . curbing hypermotility and excessive secretion in G. I. disorders

A

^

95%

EXCEL

TRIDIHEXETHYL

85%

LENT

lODIDEt
MEPROBAMATE

TRIDIHEXETHYL
lODIDEt

GO

ij ij&L v

86 PATIENTS 21 PATIENTS

i

5%

FA

IR

15%

BWTl

OR

PATHIBAMATE combines two highly effective and

well-tolerated therapeutic agents:

Meprobamate— widely accepted tranquilizer

and
PATHILON tridihexethyl chloride— antichol-
inergic noted for its effect on motility and
gastrointestinal secretion with few unwanted
side effects.

Contraindications: glaucoma, pyloric obstruction, and
obstruction of the urinary bladder neck.

t

METHANTHELINE
BROMIDE

1 ATROPINE SULFATE

PLACEBO

colic

I

'31 PATIENTS

62 PATIENTS 103 PATIENTS

Two available dosage strengths permit adjusting therap;
to the G.I. disorder and degree of associated tension.

I

Where a minimal meprobamate effect is preferred .

PATHIBAMATE-200 Tablets: 200 mg. of meprobamate;
25 mg. of PATHILON

Where a full meprobamate effect is preferred . . .

PATHIBAMATE-400 Tablets: 400 mg. of meprobamate;
25 mg. of PATHILON

Dosage: Average oral adult dose is 1 tablet
t.i.d. at mealtime and 2 tablets at bedtime.

'

Pathibamate

meprobamate with PATHILON® tridihexethyl chloride Lederle

400
200

fi

clinically proven safety

The efficacy of PATHIBAMATE has been confirmed Pictured are the results obtained with the PATHILON

clinically in duodenal ulcer, gastric ulcer, intestinal (tridihexethyl iodide)-meprobamate combination! in a

colic, spastic and irritable colon, ileitis, esophageal double-blind study of 303 ulcer patients, extending over

spasm, anxiety neurosis with gastrointestinal symp- a period of 36 months.* They clearly demonstrate the

toms, and gastric hypermotility. efficacyof PATHIBAMATE in controllingthesymptoms.

SIDE EFFECTS

DRY MOUTH

TRIDIHEXETHYL

lODIDEt
MEPROBAMATE

SAME OR MORE

TRIDIHEXETHYL
lODIDEt

5%

0%

0%

0%

0%

9%

0%

5%

23%

62%

15%

METHANTHELINE
BROMIDE

72%

28%

50%

18%

0%

3%

0%

5%

25%

52%

23%

ATROPINE SULFATE

46%

14%

34%

11%

0%

9%

6%

14%

17%

37%

46%

PLACEBO

5%

0%

1%

1%

0%

10%

0%

2%

26%

24%

50%

*Atwater, J. S., and Carson, J. M.: Therapeutic Principles in Management of Peptic Ulcer. Am. J. Digest. Dis. 4:1055 (Dec.) 1959.

fPATHILON is now supplied as tridihexethyl chloride Instead of the iodide, an advantage permitting wider use, since the latter could
distort the results of certain thyroid function tests.

y^£) LEDERLE LABORATORIES, A Division of AMERICAN CYANAMID COMPANY, Pearl River, New York

control the tension - treat the trauma

a new, improved,
more potent relaxant
for anxiety and tension

effective in half the dosage required with meprobamate

much less drowsiness than with meprobamate,
phenothiazines, or the psychosedatives

does not impair intellect, skilled performance, or normal behavior

neither depression nor significant toxicity has been reported

alert tranquillity

EMYLCAMATE

a familiar spectrum of antianxiety and muscle-relaxant activity

no new or unusual effects— such as ataxia or excessive weight gain

may be used in full therapeutic dosage even in geriatric or debilitated patients

no cumulative effect

simple, uncomplicated dosage, providing a wide margin of safety for office use

STRIATRAN is indicated in anxiety and tension, occurring alone or in

association with a variety of clinical conditions.

Adult Dosage: One tablet three times daily, preferably just before meals.

In insomnia due to emotional tension, an additional tablet at bedtime usually

affords sufficient relaxation to permit natural sleep.

Supply: 200 mg. tablets, coated pink, bottles of 100.

While no absolute contraindications have been found for Striatran in full recommended dosage,
the usual precautions and observations for new drugs are advised.

For additional information, write Professional Services,
Merck Sharp & Dohme. West Point, Pa.

MERCK SHARP &. DOHME, division of merck &. co., inc.. west point, pa.

STRIATRAN IS A TRADEMARK OF MERCK & CO., INC.

VIII NORTH CAROLINA MEIHi'Al. J()li:XAI. September, l'.ici)

Medical Society of the State of North Carolina

OFFICERS — 1960

President — Amos Neill Johnson, M.D., Garland

President Elect — Claude B. Squires, M.D., 225 Hawthorne Lane, Charlotte
Past President — John C. Reece, M.D., Grace Hospital, Morganton
First Vice-President — Theodore S. Raiford, M.D., Doctors Building, Asheville
Second Vice-President — Charles T. Wilkinson, M.D., Wake Forest
Secretary — John S. Rhodes, M.D., 700 West Morgan Street, Raleigh
Executive Director — Mr. James T. Barnes, 203 Capital Club Building, Raleigh
The President, Secretary and Executive Director are members ex-officio

of all committees
Speaker-House of Delegates — Donald B. Koonce, M.D., 408 N. 11th St., Wilmington
Vice-Speaker-House of Delegates — E. W. Schoenheit, M.D., 46 Haywood St., Asheville

COUNCILORS — 1958 - 1961

First District^-T. P. Brinn, M.D., 118 W. Market Street, Hertford

Vice Councilor — Q. E. Cooke, M.D., Murfreesboro
Second District — Lynwood E. Williams, M.D., Kinston Clinic, Kinston

Vice Councilor — Ernest W. Larkin, Jr., M.D., 211 N. Market St., Washington
Third District — Dewey H. Bridger, M.D., Bladenboro

Vice Councilor — William A. Greene, M.D., 104 E. Commerce St., Whiteville
Fourth District — Edgar T. Beddingfield, Jr., M.D., P.O. Box 137, Stantonsburg

Vice Councilor — Donnie H. Jones, M.D., Box 67, Princeton
Fifth District— Ralph B. Garrison, M.D., 222 N. Main Street, Hamlet

Vice Councilor — Harold A. Peck, M.D., Moore County Hospital, Pinehurst
Sixth District — George W. Paschal, Jr., M.D., 1110 Wake Forest Rd., Raleigh

Vice Councilor — Rives W. Taylor, M.D., P.O. Box 1191, Oxford
Seventh District —

Vice Councilor— Edward S. Bivens, M.D., Stanly County Hospital, Albemarle
Eighth District— Merle D. Bonner, M.D., 1023 N. Elm Street, Greensboro

Vice Councilor — Harry L. Johnson, M.D., P.O. Box 530, Elkin
Ninth District — Thomas Lynch Murphy, M.D., 116 Rutherford St., Salisbury

Vice Councilor — Paul McNeely Deaton, M.D., 766 Hartness St., Statesville
Tenth District — William A. Sams, M.D., Main Street, Marshall

Vice Councilor — W. Otis Duck, M.D., Drawer 517, Mars Hill

DELEGATES TO THE AMERICAN MEDICAL ASSOCIATION

Elias S. Faison, M.D., 1012 Kings Drive, Charlotte

C. F. Strosnider, M.D., 111 E. Chestnut Street, Goldsboro

Millard D. Hill, M.D., 15 W. Hargett Street, Raleigh

William F. Hollister, M.D., (Alternate), Pinehurst Surgical Clinic, Pinehurst

Joseph F. McGowan, M.D., (Alternate), 29 Market Street, Asheville

Wm. McN. Nicholson, M.D., (Alternate), Duke Hospital, Durham

SECTION CHAIRMEN 1959-1960

General Practice of Medicine — Julius Sader, M.D., 205 East Main Street, Brevard
Internal Medicine — Walter Spaeth, M.D., 116 South Road, Elizabeth City
Ophthalmology and Otolaryngology — Charles W. Tillett, Jr., M.D., 1511 Scott

Avenue, Charlotte
Surgery — James E. Davis, M.D., 1200 Broad Street, Durham
Pediatrics — William W. Farley, M.D., 903 West Peace Street, Raleigh
Obstetrics & Gynecology — H. Fleming Fuller, M.D., Kinston Clinic, Kinston
Public Health and Education — ISA C. Grant, M.D., Box 949, Raleigh
Neurology & Psychiatry — Myron G. Sandifer, M.D., N. C. Memorial Hospital,

Chapel Hill
Radiology — Isadore Meschan, M.D., Bowman Gray School of Medicine,

Winston-Salem
Pathology — Roger W. Morrison, M.D., 65 Sunset Parkway, Asheville
Anesthesia — Charles E. Whitcher, M.D., Route 1, Pfafftown
Orthopedics & Traumatology — Chalmers R. Carr, M.D., 1822 Brunswick Avenue,

Charlotte
Student AMA Chapters — Mr. John Feagin, Duke University School of Medicine.

Durham

September, 1960

ADVERTISEMENTS

IX

YEARS

senile
anxiety

disorientation

agitation

hostility

irritability

apprehension

hysteria

insomnia

chronic
urticaria

alcoholism

menopausal
syndrome

neuro-
dermatoses

functional

gastrointestinal

disorders

psychoneuroses

tension

headaches

dysmenorrhea

psychosomatic
complaints

situational
stress

asthma

hyperactivity

tics

preoperative
anxiety

enuresis
behavior
problems

ATARAX ENCOMPASSES MORE PATIENT NEEDS... LETS YOU
CHART A SAFER, MORE EFFECTIVE COURSE TO TRANQUILITY

Atarax has a wide range of flexibility . . . from
mild adult tensions and^anxieties to full-blown
alcoholic episodes . . . from the behavior dis-
orders of childhood to the emotional problems
of old age. Why? Because it gives you maximum
adaptability of dosage . . . works quickly and
predictably ... is unsurpassed in safety.

Atarax offers extra pharmacologic actions
especially useful in certain troublesome con-
ditions. It is antihistaminic and mildly anti-
arrhythmic, does not stimulate gastric secre-
tions. Hence it is well suited to the needs of
your allergic, cardiac and ulcer patients.

Have you discovered all the benefits of

ATARAX?

Dosage: Adults, one 25 mg. tablet, or one tbsp. Syrup
q.i.d. Children, 3-6 years, one 10 mg. tablet or one tsp.
Syrup t.i.d.; over 6 yeprs, two 10 mg. tablets or two tsp.
Syrup t.i.d.

Supplied: Tiny 10 mg., 25 mg., and 100 mg. tablets, bot-
tles of 100. Syrup, pint bottles. Parenteral Solution:
25 mg./cc. in 10 cc. multiple-dose vials; 50 mg./cc. in
2 cc. ampules. Prescription only.

Complete bibliography available on request.

at a MX

(BRAND OF HYDROXYZINE)

PASSPORT TO TRANQUILITY

New York 17, N. Y.

Division, Chas. Pfizer & Co., Inc.

Science for the World's Well-Being"

VITERRA

(g) for vitamin-mineral supplementation
capsules * tastitabs®
therapeutic capsules

In over five yean

Proven

in more than 750 published clinical studies

Effective

for relief of anxiety and tension

Outstandingly Safe

1 simple dosage schedule produces rapid, reliable
tranquilization without unpredictable excitation

2 no cumulative effects, thus no need tor difficult
dosage readjustments

r\ does not produce ataxia, change in appetite or libido

does not produce depression, Parkinson-like symptoms,
^ jaundice or agranulocytosis

S does not impair mental efficiency or normal behavior

Milt own

meprobamate {Wallace)

Usual dosage: One or two 400 mg. tabids t.i.d.
Supplied: 400 my. scored tabids, "00 ins*. sni;ai -mated tablets.
Also as mH'Koi'abs* — 400 nig, unmarked, coated tablets; and
as mi j'Kosi'AY- — 1UU nig. and 200 nig. continuous release capsules.

\¥/* WALLACE LABORATORIES / Cranbitiy, N. /.

(

\

of clinical use

... for the tense and nervous patient

Despite the introduction in recent years of "new and different" tranquil-
izers, Miltown continues, quietly and steadfastly, to gain in acceptance.
Meprobamate (Miltown) is prescribed by the medical profession more than
any other tranquilizer in the world.

The reasons are not hard to find. Miltown is a known drug. Its few side
effects have been fully reported. There are no surprises in store for either
the patient or the physician.

u

Gratifying" relief from

for your patients with
'low back syndrome' and
other musculoskeletal disorders

POTENT muscle relaxation
EFFECTIVE pain relief
SAFE for prolonged use

stiffness and pain

i^XdXll y llli^ relief from stiffness and pain

in 106-patient controlled study

(as reported mJ.A.M.A., April 30, 1960)

"Particularly gratifying was the drug's [Soma's]
ability to relax muscular spasm, relieve pain, and
restore normal movement ... Its prompt action,
ability to provide objective and subjective assist-
ance, and freedom from undesirable effects rec-
ommend it for use as a muscle relaxant and anal-
gesic drug of great benefit in the conservative
management of the 'low back syndrome'."

Kestler, O.: Conservative Management of "Low Back Syndrome" ,

J.A.M.A. 172: 2039 (April 30) I960.

FASTER IMPROVEMENT- 79% complete or marked

improvement in 7 days (Kestler)

EASY TO USE— Usual adult dose is one 350 mg. tablet
three times daily and at bedtime.

SUPPLIED: 350 mg., white tablets, bottles of 50.

For pediatric use, 250 mg., orange capsules, bottles of 50.

Literature and samples on request.

(CARISOPRODOL, WALLACE)

ygf WALLACE LABORATORIES, CRANBURY, NEW JERSEY

now-for
more comprehensive

control of

INDICATIONS

Head: temporomandibular
muscle spasm • Neck: acute
torticollis, osteoarthritis of cer-
vical spine with spasm of cervical
muscles, whiplash injury • Trunk and Chest: costochondritis, intercostal myositis, xiphodynia • Back:
acute and chronic lumbar strains and sprains, acute low back pain (unspecified), acute lumbar arthritis
and traumatic injury, compression fracture, herniated intervertebral disc, post-disc syndrome, strained
muscle(s) • Extremities: acute hip injury with muscle spasm, ankle sprain, arthritis (as of foot or knee),
blow to shin followed by muscle spasm, bursitis, spasm or strain of muscle or muscle group, old fracture
with recurrent spasm, Pellegrini-Stieda disease, tenosynovitis with associated pain and spasm.

-pain due to

or
-spasm of skeletal muscle

a new muscle relaxant-analgesic

Many conditions, painful in themselves, often give rise to spasm of skeletal muscles.
ROBAXISAL, the new dual-acting muscle relaxant-analgesic, treats both the pain and
the spasm with marked success: In clinical studies on 311 patients, 12 investigators1
reported satisfactory results in 86.5%. Each ROBAXISAL Tablet contains:

• A relaxant component— Robaxin* — widely recognized for its prompt long-lasting relief of
painful skeletal muscle spasm, with unusual freedom from undesired side effects WU mg.

• Methocarbamol Robins. U.S. Pat. No. 2770649-

. An analgesic component— aspirin— whose pain-relieving effect is markedly enhanced by Robaxin,
and which has added value as an anti-inflammatory and anti-rheumatic agent. . . . (i gr.) JZi mg.

INDICATIONS: Robaxisal is indicated when analgesic as
well as relaxant action is desired in the treatment of skeletal
muscle spasm and severe concurrent pain. Typical condi-
tions are disorders of the back, whiplash and other trau-
matic injuries, myositis, and pain and spasm associated with
arthritis.

SUPPLY: Robaxisal Tablets (pink-and-white, laminated)
in bottles of 100 and 500.

Also available: Robaxin Injectable, 1.0 Gm. in 10-cc am-
pul. Robaxin Tablets, 0.5 Gm. (white, scored) in bottles of
50 and 500.

■Clinical reports
C. Freeman, Jr.
Chicago Heights,

lorts in files of A H Robins Co.. Inc.. from: J. Allen, Madison. Wise.. B. Billow. New York N. Y B. Decker. Richmond Va
*£. Aulusta Ga. k. B Gordon, New York. NY., J. E. Holmblad Schenectady. N Y. L Ley. New York N. Y N Lo Bue.
ights\ HI . H. Nachman. Richmond. Va.. A. Poindexier. Los Angeles. Cal.. E. Rogers. Brooklyn. N. Y . K. H. Strong. rairteld. la.

Additional information available upon request.

Making today's medicines with integrity . . . seeking tomorrow's with persistence

XIV

NORTH CAROLINA MEDICAL JOURNAL

September, 1960

Sep

When you want to reduce serum cholesterol

and maintain it at a low level, is medication more

realistic than dietary modifications?

Maintenance of lowered cholesterol concentration in the blood
is a life-long problem. It is usually preferable, therefore,
to try to obtain the desired results through simple
dietary modification. This spares the patient added expense
and permits him meals he will relish.

The modification is based on a diet to maintain

optimum weight plus a judicious substitution

of the poly-unsaturated oils for the saturated fats.

One very simple part of the change is to cook the

selected foods with poly-unsaturated Wesson.

In the prescribed diet, this switch in type of fat

will help to lower blood serum cholesterol and

help maintain it at low levels. The use of Wesson

permits a diet planned around many favorite

and popular foods. Thus the patient finds it a

pleasant, easy matter to adhere to the prescribed course.

Where a vegetable (salad) oil is medically recom-
mended lor a cholesterol depressant regimen, Wesson
is unsurpassed by any readily available brand.
Uniformity you can depend on. Wesson has a poly-
unsaturated content better than 50% . Only the lightest
cottonseed oils of highest iodine number are selected
for Wesson. No significant variations are permitted in
the 22 exacting specifications required before bottling.

Wesson satisfies the most exacting appetites. To be

effective, a diet must be eaten by the patient. The
majority of housewives prefer Wesson particularly by
the criteria of odor, flavor (blandness) and lightness of
color. (Substantiated by sales leadership for 59 years
and reconfirmed by recent tests against the next
leading brand with brand identification removed, among
a national probability sample.)

September, 19G0

ADVERTISEMENTS

XV

Chicken, grilled with homemade
Wesson barbecue sauce, is low in
saturated fat — and delicious eating.
It gives longer lasting satisfaction.

FREE Wesson recipes, available in

quantity for your patients, show how to
prepare meats, seafoods, vegetables, salads
and desserts with poly-unsaturated
vegetable oil. Request quantity needed from
The Wesson People, Dept. N.,

210 Baronne St., New Orleans 12, La

Wesson's Important Constituents

Wesson is 100% cottonseed oil . . .

winterized and of selected quality
linoleic acid glycerides (poly-unsaturated) 50-55%

Oleic acid glycerides (mono-unsaturated) 16-20%

Total unsaturated 70-75%

Palmitic, stearic and myristic glycerides (saturated) 25-30%
Phytosterol (predominantly beta sitosterol) 0.3-0.5%

Total tocopherols 0.09-0.12%

Never hydrogenated— completely salt free

XVI NORTH CAROLINA MEDICAL JOURNAL September, 1960

WHEN ULCEROGENIC FACTORS KEEP ON WORKING...

September, 1960

ADVERTISEMENTS

XVII

REMEMBER THIS: SO DOES ENARAX

Think of your patient with peptic ulcer— or with gastrointestinal
dysfunction — on a typical day.

Think of the anxieties, the tensions.

Think, too, of the night: the state of his stomach emptied of food.

Disturbing?

Then think of enarax. For enarax was formulated to help you control pre-
cisely this clinical picture, enarax provides oxyphencyclimine, the in-
herently long-acting anticholinergic (up to 9 hours of actual achlorhydria1)
. . . plus Atarax, the tranquilizer that doesn't stimulate gastric secretion.

Thus, with b.i.d. dosage, you provide continuous antisecretory/antispas-
modic action and safely alleviate anxiety . . . with these results: enarax
has been proved effective in 92% of G.I. patients.2-4

When ulcerogenic factors seem to work against you, let enarax work
for you.

ENARAX

(lO MG. OXYPHENCYCLIMINE PLUS 25 MG. ATARAX®!) A SENTRY FOR THE G.I. TRACT

dosage: Begin with one-half tablet b.i.d. — preferably in the morning and before retiring.
Increase dosage to one tablet b.i.d. if necessary, and adjust maintenance dose according
to therapeutic response. Use with caution in patients with prostatic hypertrophy and only
with ophthalmological supervision in glaucoma.

supplied: In bottles of 60 black-and-white scored tablets. Prescription only.

References: 1. Steigmann, F., et al.: Am. J. Gastroenterol. 33:109 (Jan.) 1960. 2. Hock, C. W.:
to be published. 3. Leming, B. H., Jr.: Clin. Med. 6:423 (Mar.) 1959. 4. Data in Roerig Medical

Department Files. tbrand of hydroxyzine

FOR HEMATOPOIETIC STIMULATION
WHERE OCCULT BLEEDING IS PRESENT

HEPTUNA® PLUS

THE COMPLETE ANEMIA THERAPY

New York 17, N.Y.

Division, Chas. Pfizer & Co., Inc.

Science for the World's Well-Being '

completely c

f the common cold

r\

your patients suffering from colds, respiratory disorders and allergic states, you will
CONTRAMAL-CP an orally effective DECONGESTANT, ANALGESIC, ANTIPYRE-
and ANTIHISTAMINE. The inclusion of Tristamine* and Phenylephrine Hydrochlo-
with the basic CONTRAMAL formula is designed to provide . . . MORE complete
rol of the common cold!

V

*A

stam

by Physicians Products Company
ontains Chlorpheniramine Maleate
.25 mg., Phenyltoloxamine Citrate

6.25 mg., and Pyrilamine Maleate
2.5 m

i

r

Mi

\

TRAMAL-CP . .
orange capsule con

Acetyl-p-aminophenol

Salicylamide
Caffeine
henylephrine Hydrochloride

At '

ristamine ■

30 mg.

5 mg.

20 mg.

V

\

V

rV» <*M

samples -And
literature
gladly sent
upon request,

PRODUCTS CO., INC.

PETERSBURG, VIRGINIA

effective oral skeletal
muscle relaxant
and tranquilizer

LETS THE PATIENT WALK
"HEADS UP"

in spite of torticollis.

-^m^-^mmm

Trancopal

relieves pain and spasm
associated with torticollis.

In a recent study by Ganz, Trancopal brought considerable
improvement or very effective relief to 20 of 29 patients
with torticollis.1 "The patients helped by the drug," states
Ganz, "were able to carry the head in the normal position
without pain." Similarly, Kearney found that in 8 of 13
patients with chronic torticollis treated with Trancopal
improvement was excellent to good. ". . . Trancopal is the most
effective oral skeletal muscle relaxant and mild tranquilizer
currently available."2

Lichtman, in a study of patients with various musculoskel-
etal conditions, noted that 64 of 70 patients with torticollis
obtained excellent to good relief with Trancopal.3

In a comparative study of four central nervous system
relaxants, Lichtman reports that 26 of 40 patients
found Trancopal to be the most effective drug.3

Trancopal (brand of chlormezanone) and Caplets, trademarks reg. U. S. Pat. Off. 4716

1. Ganz. S. E.: J. Indiana A
52:1134. July, 1959. 2. Kearney, I
Current Therap. Res. 2:127
1960. 3. Lichtman. A. L.: Ken
Acad. Gen. Pract. J. 4:28. Oct.,

Olinical results with

IrancopaF

Excellent

Good

Fair

Poor

Total

LOW BACK SYNDROMES

Acute low back strain
Chronic low back strain
"Porters' syndrome"*
Pelvic fractures

25

11

21

2

19
5
5
1

8
1
1

6
1

1

58

18

28

3

NECK SYNDROMES

Whiplash injuries
Torticollis, chronic

12
6

6
2

2

3

1
2

21
13

OTHER MUSCLE SPASM

Spasm related to trauma
Rheumatoid arthritis
Bursitis

15
2

6

18

6

1
2
1

1

22

21
9

TENSION STATES

18

2

4

3

27

TOTALS

112
(51%)

70
(32%)

23

(10%)

15

(7%)

220

(100%)

*Over-reaching in lifting heavy bags resulting in sprain of upper, middle, and lower back muscles.

Dosage: Adults, 200 or 100 mg. orally three or four times daily.

Relief of symptoms occurs in from fifteen to thirty minutes and lasts from four to six hours.

How Supplied: Trancopal Caplets®

200 mg. (green colored, scored), bottles of 100.
100 mg. (peach colored, scored), bottles of 100.

I Ijtiitn/iob

LABORATORIES, New York 1 8, N. Y.

XX

NORTH CAROLINA MEDICAL JOURNAL

September. ISmO

a

extraordinarily effective diuretic..'!1

Efficacy and expanding clinical use are making Naturetin the
"diuretic of choice"2 in edema and hypertension. It maintains a
favorable urinary sodium-potassium excretion ratio, retains a
balanced electrolyte pattern, and causes a relatively small in-
crease in the urinary pH.3 More potent than other diuretics,
Naturetin usually provides 18-hour diuretic action with just a
single 5 mg. tablet per day — economical, once-a-day dosage
for the patient. Naturetin c K — for added protection in those
special conditions predisposing to hypokalemia and for patients
on long-term therapy.

Supplied: Naturetin Tablets, 5 mg., scored, and 2.5 mg. Naturetin
c" K (5 c 500) Tablets, capsule-shaped, containing 5 mg. ben-
zydroflumethiazide and 500 mg. potassium chloride. Naturetin
c K (2,5 c 500) Tablets, capsule-shaped, containing 2.5 mg.
benzydroflumethiazide and 500 mg. potassium chloride. For com-
plete information consult package circular or write Professional
Service Dept., Squibb, 745 Fifth Avenue, New York 22, N. Y.

Pe/erences: 1. Dovid, N. A.; Porter, G. A., and Gray, R. H.: Monographs
on Theropy 5:60 (Feb.) 1960. 2. Friend, D. H.; Clin. Pharm. & Therap. 1:5
(Mar.-Apr.) 1960. 3. Ford, R. V.: Current Therap. Res. 2:92 (Mar.) 1960.

Naturetin Naturetin °K

Squibs

September, 1960

ADVERTISEMENTS

XXI

A. H. Robins'
new Adabee —
for the physician
ivho has
iveighed the . . .

MOUNTING
EVIDENCE

AGAINST

IN

MULTI-
VITAMINS

Bi2AND
FOLIC ACID

jouroji of Medicim:

rj

"^•^^Lj

Individually, folic acid and B12 fill important clinical roles.1
But, increasing evidence indicates that multivitamins con-
taining folic acid may obscure the diagnosis of pernicious
anemia.2"7 And vitamin B12. in indiscriminate and unneces-
sary usage5"8 is likewise blamed for this diagnostic con-
fusion.7

Both folic acid and B12 have been omitted from Adabee, in
recognition of this growing medical concern. Also excluded
are other factors which might interfere with concurrent ther-
apy, such as, hormones, enzymes, amino acids, and yeast
derivatives. Adabee supplies massive doses of therapeutically
practical vitamins for use in both specific and supportive
schedules in illness and stress situations. Thus, new Adabee
offers the therapeutic advantage of sustained maximum
multivitamin support without the threat of symptom-masking.

references: 1. Wintrobe, M. M., Clinical Hematology, 3rd ed.,
Phila., Lea & Febiger, 1952, p. 398. 2. Goodman, L. S. and Gilman,
A., The Pharmacological Basis of Therapeutics, 2nd. ed., New
York, Macmillan, 1955, p. 1709. 3. New Eng. J.M., Vol. 259, No.
25, Dec. 18, 1958, p. 1231. 4. Frohlich, E. D., New Eng. J.M.,
259:1221, 1958. 5. J.A.M.A., 169:41, 1959. 6. J.A.M.A., 173:240,
1960. 7. Goldsmith, G. A., American J. of M., 25:680, 1958. 8.
Darby, W. J., American J. of M., 25:726, 1958.

ADABEE®

Each yellow, capsule-shaped tablet contains:

Vitamin A
Vitamin D

Thiamine mononitrate (Bj)
Riboflavin (Bo)
Pyridoxine HC1 (B6)
Nicotinamide (niacinamide)
Calcium pantothenate
Ascorbic acid (vitamin C)

ADABEE? M

Each green, capsule-shaped tablet contains Adabee plus nine
essential minerals:

25,000 USP units

1,000 USP units

15 mg.

10 mg.

5 mg.

50 mg.

10 mg.

250 mg.

Iron

15.0 mg.

Zinc

1.5

mg.

Iodine

0.15 mg.

Potassium

5.0

mg.

Copper

1.0 mg.

Calcium

103.0

mg.

Manganese

1.0 mg.

Phosphorus

80.0

mg.

Magnesium

6.0 mg.

indications: As dietary supplements for the deficiency states
that accompany pregnancy and lactation, surgery, burns,
trauma, alcohol ingestion, hyperthyroidism, infections, car-
diac disease, polyuria, anorexia, cirrhosis, arthritis, colitis,
diabetes mellitus. and degenerative diseases. Also in re-
stricted diets, particularly peptic ulcer, in geriatrics, and in
concurrent administration with diuretics and antibiotics.

dosage: One or more tablets a day, as indicated, preferably
with meals. _ _

new! ADABEE

the multivitamin without B12 or folic acid

A. H. ROBINS COMPANY, INC.

Richmond 20, Virginia

I wouldn't be hooting
all night if I were able
to get my beak on some

TRIAMINIC®

to clear up my
stuffed sinuses."

=

Your patient with sinus congestion doesn't give a hoot about anything

but prompt relief. And TRIAMINIC has a pharmacologically balanced

formula designed to give him just that. As soon as he swallows the

and for humans tablet, the medication is transported systemically to all nasal and

paranasal membranes — reaching inaccessible sinus cavities where
With ol U if r hi D - U XT drops and sprays can never penetrate. TRIAMINIC thereby brings

q TTsjTTQTfC; more complete, more effective relief without hazards of topical ther-

apy, such as ciliary inhibition, rebound congestion, and "nose drop
addiction."

hid icat ions: nasal and paranasal congestion, sinusitis, postnasal drip,
upper respiratory allergy.

Relief is prompt and prolonged Each Triaminic timed-release Tablet provides:

because of this special timed-release action: raSffiSTSJKrt! HC'. :.'.'.'.'.'.'.'.'.'.'.. . IsSfi

Pyrilamine maleate 25 mg.

fir<tt —the outer laver Dosage: 1 tablet in the morning, midafternoon and at bedtime.

^A^K dissolves within '" Postnasal drip, 1 tablet at bedtime is usually sufficient.

_ ^ minutes to produce Each timed-release Triaminic Juvelet® provides:

^^^^ I 3 to 4 hours of relief ,. .. . ... . .. _ . . . _, ,, .

^^ \^_ ^/ % the formulation of the Triaminic Tablet.

"~^\ ^nen — the core Dosage: 1 Juvelet in the morning, midafternoon and at bedtime,

disintegrates to ,-, , ,_ , , , _, . . . „ .,

give 3 to 4 more Each tsp- (5 ml^ °* "TOfllMltC Syrup provides:

hours of relief % the formulation of the Triaminic Tablet.

Dosage (to be administered every 3 or 4 hours) :
Adults — 1 or 2 tsp.; Children 6 to 12 — 1 tsp.;
Children 1 to 6 — % tsp.; Children under 1 — lA tsf.

JL. -LT\j JL^Tjk. XV JL -L JL^I J- \~*S timed-release tablets, juvelets, and syrup

running noses '-^> ^-, and open stuffed noses orally

SMITH-DORSEY • a division of The Wander Company • Lincoln, Nebraska

T

Mo
inti

::;
the
ill
thi;
.::

. : ■ ., .;

\

Doctors, too, like "Premarinl'

The doctor's room in the hospital
is used for a variety of reasons.
Most any morning, you will find the
internist talking with the surgeon,
the resident discussing a case with
the gynecologist, or the pediatrician
in for a cigarette. It's sort of a club,
this room, and it's a good place to
get the low-down on "Premarin"
therapy.

If you listen, you'll learn not only
that doctors like "Premarin," but
why they like it.

The reasons are fairly simple.
Doctors like "Premarin," in the first
place, because it really relieves the
symptoms of the menopause. It
doesn't just mask them — it replaces
what the patient lacks — natural es-
trogen. Furthermore, if the patient

is suffering from headache, insomnia,
and arthritic-like symptoms due to
estrogendeficiency,"Premarin"takes
care of that, too.

"Premarin," conjugated estrogens
(equine), is available as tablets and
liquid, and also in combination with
meprobamate or methyltestosterone.
Ayerst Laboratories • New York
16, N. Y. • Montreal, Canada

What's she doing that's of medical interest?

5 drinking a glass of pure Florida
ge juice. And that's important to
physician for several reasons.
ow your patients obtain their vita-
: or any of the other nutrients found
trus fruits is of great medical inter-
■ considering the fact there are so
y wrong ways of doing it, so many
titutes and imitations for the real

g-

ctually, there's no better way for
young lady to obtain her vitamin C
i by doing just what she is doing,

for there's no better source than oranges
and grapefruit ripened in the Florida
sunshine. There's no substitute for the
result of nature's own mysterious chem-
istry, flourishing in the warmth of this
luxurious peninsula.

An obvious truth, you might say, but
not so obvious to the parents of many
teen-agers.

We know that a tall glass of orange
juice is just about the best thing they
can reach for when they raid the refrig-
erator. We also know that if you en-

courage this refreshing and healthful
habit among your young patients — and
for that matter, your patients of any age
— you'll be helping them to the finest
between-meals drink there is.

Nothing has ever matched the quality
of Florida citrus— watched over as it
is by a State Commission that enforces
the world's highest standards for quality
in fresh, frozen, canned or cartoned
citrus fruits and juices.

That's why the young lady's activities
are of medical interest.

©Florida Citrus Commission, Lakeland, Florida

in premenstrual tension

only
treats the whole syndrome

o Bromth

It was the introduction of neo Bromth several years ago that created such widespread
interest in the premenstrual syndrome — because of neo Bromth's specific ability
to prevent the development of the condition in the first place.

The action of neo Bromth is not limited merely to control of abnormal water retention,
or of nervousness, or of pain — or any other single or several of the multiple
manifestations characteristic of premenstrual tension, neo Bromth effectively controls
the whole syndrome.

neo Bromth is also completely free from the undesirable side effects associated with
such limited-action therapy as ammonium chloride, hormones, tranquilizers and potent
diuretics, neo Bromth has continued to prove to be the safest — as well as the most
effective — treatment for premenstrual tension.

Each 80 mg. tablet contains 50 mg. Pamabrom, and 30 mg. pyrilamine maleate.
Dosage is 2 tablets twice daily (morning and night) beginning 5 to 7 days before
menstruation. Discontinue when the flow starts.

BRAYTEN PHARMACEUTICAL COMPANY . Chattanooga 9, Tennessee

m

NEW For the

multi-system disease

HYPERTENSION

" — nuiA

Hydroflumethiazide • Reserpine • Protoveratrine A

UTEf

In each SALUTENSIN Tablet:
Saluron® (hydroflumethiazide) —

a saluretic-antihypertensive 50 mg.

Reserpine — a tranquilizing drug with

peripheral vasorelaxant effects 0.125 mg.

Protoveratrine A — z centrally mediated

vasorelaxant 0.2 mg.

An integrated multi-therapeutic
antihypertensive, that combines in balanced pro-
portions three clinically proven antihypertensives.

Comprehensive information on dosage and precautions
in official package circular or available on request.

BRISTOL LABORATORIES • Syracuse, New York

September, 1960

ADVERTISEMENTS

XXVII

Following determination
of basal secretion,
intragastric pH was
continuously determined
by means of frequent
readings over a
two-hour period.

PH Data based on pH measurements in 11 patients with peptic ulcer*

4.9

Neutralization
with new Creamalin

4.5

3.S i ;

3.0

2.5

i J

A 3-5

1

Neutralization \
with standard
aluminum hydroxide

^^3.1

"\2.0

m neutralization
is much
faster and
twice
as long
with

Minutes 20

60

80

120

■" CREAMALIN ANTAC,°

LABORATORIES ■
New York 18, N. Y.

TABLETS

New proof in vivo' of the much greater efficacy of new Creamalin
tablets over standard aluminum hydroxide has now been ob-
tained. Results of comparative tests on patients with peptic ulcer,
measured by an intragastric pH electrode, showthat newCreamalin
neutralizes acid from 40 to 65 per cent faster than the standard
preparation. This neutralization (pH 3.5 or above) is maintained
for approximately one hour longer.

New Creamalin provides virtually the same effects as a liquid
antacid2 with the convenience of a tablet.
Nonconstipating and pleasant-tasting, new Creamalin antacid
tablets will not produce "acid rebound" or alkalosis.
Each new Creamalin antacid tablet contains 320 mg. of specially
processed, highly reactive, short polymer dried aluminum hy-
droxide gel (stabilized with hexitol) with 75 mg. of magnesium
hydroxide. Minute particles of the powder offer a vastly increased
surface area for quicker and more complete acid neutralization.

Dosage: Gastric hyperacidity — from 2 to 4 tablets as necessary. Peptic
ulcer or gastritis — from 2 to 4 tablets every two to four hours. Tablets may
be chewed, swallowed whole with water or milk, or allowed to dissolve
in the mouth. How supplied: Bottles of 50, 100, 200 and 1000.
1. Data in the files of the Department of Medical Research, Winthrop
Laboratories. 2. Hinkel, E. T., Jr.; Fisher, M. P., and Tainter, M. L.: J. Am.
Pharm. A. (Scient. Ed.) 48:384, July, 1959.

for peptic ulcere gastritis* gastric hyperacidity

Sometimes,
when I have
a running nose,
I'd like to
clear it with

TRIAMINIC^
just to check out
that systemic
absorption business.

Reaches all nasal
and paranasal
membranes, huh?"

. . . and for humans ^ ou can't reach the entire nasal and paranasal mucosa by putting

medication in a man's nostrils — any more than you could by trying to
With pour it down an elephant's trunk. TRIAMINIC, by contrast, reaches all

:?TTN"MT'Nrr "NTOCJTT Q respiratory membranes systemicaMy to provide more effective, longer-

lasting relief. And TRIAMINIC avoids topical medication hazards such
as ciliary inhibition, rebound congestion, and "nose drop addiction."

Judications: nasal and paranasal congestion, sinusitis, postnasal drip,
upper respiratory allergy.

ielief IS prompt and prolonged Each Triaminic timed-release Tablet provides:

because of this special timed-release action: Phenylpropanolamine hci . .50 mg.

Pheniramine maleate 2o mg.

Pyrilamine maleate 25 mg.

first— the outer laver Dosage: 1 tablet in the morning, midafternoon and at bedtime,

dissolves within ' 'n Postnasa' drip, 1 tablet at bedtime is usually sufficient.

minutes to produce Each timed-release Triaminic Juvelet® provides:

3 to 4 hours of relief ,, ., - ... . ,, _ . „ ,, .

\z the formulation of the Triaminic Tablet.

then— the core Dosage: 1 Juvelet in the morning, midafternoon and at bedtime.

disintegrates to „ , . ,„ , , , m . . . 0 . ,

give 3 to 4 more ' tsp' ^5 ""•' o) Tr'aml>uc Syrup provides:

hours of relief '' tne i°rm"lation of the Triaminic Tablet.

Dosage (to be administered every 3 or 4 hours) :

Adults — 1 or2 tsp.; Children « to 12- 1 tsp.;

Children 1 to 6 — Vi tsp.; Children under 1 — Vt tsp.

J- -L \j -L ^» A. -L V -1_ X i. i JL V»y timed-release tablets, jtii'elets, and syrup
j| running noses ^t-, ^^ an<^ °Pen stuffed noses orally

SMITH-DORS EY • a division of The Wander Company • Lincoln, Nebraska

September, 1960

ADVERTISEMENTS

XXIX

ALL OVER AMERICA!

KENTwiththe MICRONITE FILTER

IS SMOKED BY
MORE SCIENTISTS and EDUCATORS

than any other cigarette!*

FIVE

TOP

BRANDS

OF

CIGARETTES

SMOKED

BY AMERICAN

SCIENTISTS

KENT.

15.3%

BRAND "A" 1
BRAND "G c

10.5%
7.9%

BRAND F a

7.6%

BRAND "B

7.3%

FIVE TOP BRANDS OF CIGARETTES
SMOKED BY AMERICAN EDUCATORS

KENT ■■■■■■■■■■■.^■■■^■^■■■■■H 20.2%

BRAND "G KiwMaeffi 6.0%

BRAND "E' S3KS5s*sssss*sas 7.7%

BRAND "A" mwH— M 7.7%

BRAND "F" ■"! "■— .» 7.0%

This does not constitute a
professional endorsement
of Kent. But these men, like
millions of other Kent smokers,
smoke for pleasure, and choose
their cigarette accordingly.

The rich pleasure of smoking
Kent comes from the flavor
of the world's finest natural
tobaccos, and the free and
easy draw of Kent's famous
Micronite Filter.

If you would like the booklet, "The Story of Kent", for your
own use, write to: P. Lorillard Company — Research De-
partment, 200 East 42nd Street, New York 17, New York.

For good smoking taste,
it makes good sense to smoke

;fc Results ot a continuing study of cigarette preferences, conducted by O'Brien Sherwood Associates, N Y., NY.
A PRODUCT OF P LORILLARD COMPANY FIRST WITH THE FINEST CIGARETTES THROUGH LORiLLARD RESEARCH

I0-S1II.
IEOULAI Sill

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Thanks to your prompt
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often in a few days. She
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and soon returns to her
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4\

Lifts depression. ..as it calms anxiety!

Smooth, balanced action lifts depression as
it calms anxiety. . . rapidly and safely

Balances the mood — no "seesaw" effect
of amphetamine -barbiturates and ener-
gizers. While amphetamines and energizers may
stimulate the patient — they often aggravate
anxiety and tension.

And although amphetamine-barbiturate combina-
tions may counteract excessive stimulation — they
often deepen depression.

In contrast to such "seesaw" effects, Deprol's
smooth, balanced action lifts depression as it calms
anxiety — both at the same time.

Dosage: Usual starting dose is 1 tablet
q.i.d. When necessary, this dose may be grad-
ually increased up to 3 tablets q.i.d.

Composition: 1 mg. 2-diethylaminoethy] benzi-
late hydrochloride tbenactyzine HC1I and 400 mg.
meprobamate. Supplied: Bottles of 50 light-pink,
scored tablets. Write for literature and samples.

Acts swiftly— the patient often feels
better, sleeps better, within a few days.

Unlike the delayed action of most other antide-
pressant drugs, which may take two to six weeks
to bring results, Deprol relieves the patient quickly
—often within a few days. Thus, the expense to the
patient of long-term drug therapy can be avoided.

Acts safely — no danger of liver damage.

Deprol does not produce liver damage, hypoten-
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function — frequently reported with other anti-
depressant drugs.

ADeprol

A®

WALLACE LABORATORIES/AVw Brunswick, N. J.

who coughed?

u

WHENEVER COUGH THERAPY
IS INDICATED

HYCOMINE

Syrup

cough sedative / antihistamine
decongestant / expectorant

THE COMPLETE Rx
FOR COUGH CONTROL

relieves cough and associated symptoms in 15-20
minutes ■ effective for 6 hours or longer ■ pro-
motes expectoration ■ rarely constipates ■ agree-
ably cherry-flavored

Each teaspoonful (5 cc.) of Hycomine* Syrup contains:
Hycodan®

Dihydrocodeinone Bitartrate 5 mg."|

(Warning: May be habit-forming) > 6.5 mg.

Homatropine Methylbromide 1.5 mg.j

Pyrilamine Maleate 12.5 mg.

Phenylephrine Hydrochloride 10 mg.

Ammonium Chloride 60 mg.

Sodium Citrate 85 mg.

Average adult dose: One teaspoonful after meals and at bedtime.
May be habit-forming. Federal law permits oral prescription.

Literature on request

ENDO LABORATORIES

Richmond Hill 18, New York

, ?U.S. Pat. 2,630.400

Dimetane

i distinguished by its
'. . .very low incidence of
undesirable side effects . . ."*

■

HIHIHI

9amt

even m
allergic
infants

FROM A CLINICAL STUDY* IN ANNALS OF ALLERGY

Patients

200 infants and children, ages 2 months to 14 years

Diagnosis

Perennial allergic rhinitis

Therapy

Dimetane Elixir

Results

in 149, good results / in 40, fair results

Side Effects

Encountered in only 7 patients (in all except one,
the side effect was mild drowsiness)

\

■

In allergic patients of all ages, Dimetane has been shown to work with an effec-
tiveness rate of about 90% and to produce an exceptionally low incidence
of side effects. Complete clinical data are available on request to the Medical
Department. Supplied: dimetane Hxientabs (12 mg.), Tablets l§^tfttt^:
(4 mg.), Elixir (2 mg./5 cc), new dimetane-ten Injectable (l^Sfl^aR
(10 mg./cc.) or new dimetane-100 Injectable (100 mg./cc). '/Sl^SMA

NNALS OF ALLEROY 17:913, 1951).

A. H. ROBINS CO., INC., RICHMOND 20, VIRGINIA/ETHICAL PHARMACEUTICALS OF MERIT SINCE 1878

t PARABROMDYLAMINE MALEATE

3

> -yv

Ai

ACUTE BRONCHITIS

SYNCILLIN

250 mg. t.i.d. - 6 days

H.F. 45-year-old white female. First seen on
Aug. 24, 1959 with acute bronchitis of 3 days1
duration. Culture of the sputum revealed alpha
hemolytic streptococci. A 250 mg. SYNCILLIN
tablet was administered 3 times daily. Another
sputum culture taken on Aug. 27 showed no growth.
On Aug. 30, the patient appeared much improved
and SYNCILLIN was discontinued.
Recovery uneventful. - *k

Actual case summary from the files of Bristol Laboratories' Medical Department

THE ORIGINAL potassium phenethicillin

SYNCILLIN

(Potassium Penicillin- 152)
A dosage form to meet the individual requirements of patients of all ages in home, office, clinic, and hospital :

Syncillin Tablets - 250 mg. (400,000 units) . . . Syncillin Tablets - 125 mg. (200,000 units)

Syncillin for Oral Solution - 60 ml. bottles - when reconstituted, 125 mg. (200,000 units) per 5 ml.

Syncillin Pediatric Drops - 1.5 Gm. bottles. Calibrated dropper delivers 125 mg. (200,000 units)

Complete information on indications, dosage and precautions is included in the circular accompanying each package.

BRISTOL LABORATORIES, SYRACUSE, NEW YORK (jWroi

XXXI V

NORTH CAROLINA MEDICAL JOURNAL

September, 1960

experience
dictates
V-CILLIN K

fOr maximum effeCtiVeneSS Recently, Griffith' reported that V-Cillin
K produces antibacterial activity in the serum against penicillin-sensitive patho-
gens which is unsurpassed by any other form of oral penicillin. This helps explain
why physicians have consistently found that V-Cillin K gives a dependable
clinical response.

fOr Unmatched Speed Peak levels of antibacterial activity are attained
within fifteen to thirty minutes — faster than with any other oral penicillin.1

fOr UnSUrpaSSed Safety The excellent safety record of V-Cillin K is
well established. There is no evidence available to show that any form of peni-
cillin is less allergenic or less toxic than V-Cillin K.

Prescribe V-Cillin K in scored tablets of 125 and 250 mg., or V-Cillin K, Pediatric,
in 40 and 80-cc. bottles.

1. Griffith, R. S.: Comparison of Antibiotic Activity in Sera Following the Administration of
Three Different Penicillins, Antibiotic Med. & Clin. Therapy. 7:No. 2 (February), 1960.

V-CILLIN K® (penicillin V potassium, Lilly)

ELI LILLY AND COMPANY

INDIANAPOLIS 6, INDIANA, U.S.A.

033CO1

North Carolina Medical Journal

Owned and Published by
The Medical Society of the State of North Carolina

Volume 21

September, 1960

No. 9

Meeting North Carolina's Occupational Health Needs
Through Our State Agencies

Emil T. Chanlett*
Chapel Hill

In our occupational pursuits, there are
two important standards of measurement.
One is external — that of productivity. The
other is internal — that of personal gratifi-
cation, as we seek to be worthy of our own
self-esteem and the esteem of those who work
and live with us. In this process importance
of physical and mental well-being is so ob-
vious that one wonders why so little con-
certed study has been directed to the rela-
tionship between occupation and health. We
are all aware of our individual efforts in this
matter and may even take some pride in our
accomplishments. The particular business of
this Occupational Health Council is to con-
sider how we may direct our efforts in con-
cert, with a reasonable expectation of larger
benefits and greater returns through our in-
tegrated strength.

A variety of definitions have been pro-
posed for occupational health, and many of
these are useful. The intuitive concept of
the term is accurate. Concretely, it means
that employees and employers in good health
enjoy fatter pay checks, more efficient pro-
duction, and larger profits. Therefore, a mat-
ter of such importance merits the expendi-
ture of time, thought, and money.

The factors making for good or bad health
at work are much the same as those operat-
ing elsewhere, although they may differ in
character and intensity. There are accidents.
There is exposure to poisonous gases, vapors,
dusts, and fumes; to unusual forms of phy-
sical energy such as radiation, noise, heat,
and light. There is exposure to, and contrac-
tion of, communicable diseases. There is the
degeneration or loss of full physiologic func-
tion of our various organs and members, in-

♦Professor of Sanitary Engineering, the School of Public
Health, University of North Carolina. Chapel Hill.

eluding our skin. There are the manifold in-
fluences that determine our feelings and
modes of adaptation, which have much to do
with our effectiveness and our happiness. All
these factors are the concern of this Council,
with the exception of the prevention of acci-
dents in industry. Comparable councils are
already dealing with accidents and aiding
the agencies which face the grim task of
reducing accident tolls.

There are four state agencies which have
direct responsibilities and functions in occu-
pational health in our state. Three deal with
the prevention and detection of and the com-
pensation for occupational diseases. Por-
tions of these functions are allocated by sta-
tute to the Department of Labor, the Indus-
trial Commission, and the State Board of
Health. The fourth is concerned with the
salvage through vocational rehabilitation of
those disabled by disease or injury. The Di-
vision of Vocational Rehabilitation within
the State Board of Education serves the vic-
tims not only of occupational disabilities, but
of other misfortunes as well. The occupa-
tional health activities of these agencies have
been substantially confined to the narrow
front of occupational disease control. This is
in keeping with our North Carolina statutes
and the codes and rules made under them
which are explicit with regard to specific
functions of three of the agencies. A brief
review of their powers and functions will be
useful.

Department of Labor

Our Labor Department has the powers of
inspection, enforcement, and prosecution un-
der all laws relating to conditions of work.
These include rule-making powers pertain-
ing to accidents and occupational diseases.
Rules have been promulgated relating to all

358

NORTH CAROLINA MEDICAL JOURNAL

September, 1960

industries and to particular places of work,
including requirements for adequate exhaust
ventilation systems to remove dust, gases,
and fumes known to be capable of producing
occupational diseases. The Labor Depart-
ment also regulates matters of cleanliness,
sanitary facilities, lighting, and air-condi-
tioning.

The Labor Department's contribution in
the area of occupational disease and the
broader field of occupational health has been
to provide legal enforcement when and where
needed. Its field staff has provided educa-
tional material to employers and employee
groups, and has collaborated in special
courses for supervisory personnel and those
particularly concerned with safety and
health. In its series of industrial safety
courses conducted in cooperation with North
Carolina State College, the environmental
phases of occupational disease control have
received attention.

The field staff of safety supervisors and
inspectors of the Labor Department have
provided, through their observation during
routine visits, many leads on hazardous situ-
ations capable of producing occupational dis-
ease. These have been referred to the staff
of the State Board of Health for study and
recommendations. The Department's activi-
ties, although directed primarily to the pre-
vention of accidents, has prepared the
groundwork among employers and employees
for a better understanding of their joint re-
sponsibilities for health and safety.

Indiistrial Com mission

All of us are familiar with the over-all re-
sponsibilities of the Industrial Commission,
an autonomous administrative agency with-
in the Labor Department. Its responsibili-
ties for occupational health are clearly de-
fined in terms of occupational diseases. This
agency is responsible for the adjudication of
compensation claims arising from any of the
specifically stated 26 causes or conditions
capable of producing occupational disease.
In compensation law our North Carolina act
is referred to as a scheduled coverage of oc-
cupational diseases, as claims may be made
only for the causes or conditions stated in
the law. The Industrial Commission has had
a particular concern for claims arising from
silicosis and asbestosis, as these conditions
had much to do with the creation of our com-
pensation law. The statute creating the In-

dustrial Commission requires the reporting
of occupational disease, and provides for a
medical advisory committee to assist in eval-
uating cases and for determining the fitness
of employees for work in the dusty trades.

The Industrial Commission has faithfully
administered our compensation law, includ-
ing the orderly and rapid processing of
claims arising from occupational diseases
with a continued emphasis and stress upon
the diseases arising in the dusty trades. The
staff of the Commission has provided safety
instruction, through organized classes,
through its publications, and through the
promotion of the Annual State-Wide Safety
Conference. In all these media, the import-
ance of occupational diseases as a cause of
disability and death has received compelling
attention.

The Industrial Commission is an indis-
pensable and valuable source of statistical
data on the cases, claims, disabilities, and
deaths arising from occupational diseases,
and on the direct cost which these impose
upon us all. A by-product of one of its stud-
ies of factors contributing to industrial ac-
cidents is new knowledge on the importance
of healthful living to the efficiency and hap-
piness of employees. A staff study has shown
that the sort of breakfast eaten and how a
weekend is spent influence the frequency and
time of occurrence of industrial accidents.
These observations recently captured nation-
wide attention. It was certainly an interest-
ing hint of the potential that we have for
working together in occupational health.

Division of Vocational Rehabilitation
The Division of Vocational Rehabilitation
has the function of renewing people for em-
ployment who have been disabled, through
any means, in any place, or under any con-
ditions. Its services are not restricted to
those whose disability has been incurred in
the course of employment. Working coop-
eratively with a federal agency, this organi-
zation provides services for the disabled
which embrace medical repair, counsel, guid-
ance and training, and assistance in finding
a new and productive place in our society.
It is a process of restoration which pays rich
dividends in self-respect and in lightening
the community's cost for carrying the un-
fortunate.

State Board of Health
Our State Board of Health has general
as well as specific powers and responsibili-

September, 1960

MEETING OCCUPATIONAL HEALTH NEEDS— CHANLETT

359

ties with regard to occupational health. Un-
der its general powers relating to health and
sanitary conditions, the power to investigate
the effect of employment upon the public
health is specifically mentioned.

The Occupational Health Section of the
State Board of Health, formerly known as
the Division of Industrial Hygiene, is desig-
nated as the technical and professional agent
of the Industrial Commission for the detec-
tion and prevention of occupational diseases
and for medical advice in the adjudication
of claims. Although its activities have been
closely related to the needs of the Industrial
Commission, the Occupational Health Sec-
tion is an integral part of the State Board
of Health. A small group of specialized per-
sonnel was originally made possible through
federal funds to which this state was entitled
under the Social Security Act. Federal as-
sistance continues, although there is now
substantial support from the state. The staff
presently consists of a medical director, an
industrial nurse, two industrial hygiene en-
giners, two industrial hygienists, x-ray tech-
nicians, and secretarial personnel.

This group directly serves the dusty trades
by providing x-ray examinations of all em-
ployees exposed to silica or asbestos dust,
with further physical evaluation when
needed. A physician supplies medical infor-
mation for compensation hearings through
reports, affidavits, and even direct testimony
when required. A field engineering staff car-
ries out an extensive schedule of air-samp-
ling to determine dust concentration where
silica or asbestos are present. This same
group makes recommendations for dust con-
trol by appropriate engineering methods
such as ventilation, isolation, and wetting.

In spite of the fact that the direct services
rendered the dusty trades make heavy de-
mands on the time and funds of the small
staff, the group has provided medical and
engineering services as well as air-sampling
in all instances of known or suspected cases
of occupational disease which have been
brought to its attention. Requests for such
services arise from the Industrial Commis-
sion, the Labor Department, the North Caro-
lina Rating Bureau, from industrial man-
agement and employee groups, and occa-
sionally from local health departments.
There have been numerous field studies of
exposure to such notorious toxic substances
as lead, benzol, zinc oxide, vapors of paint
solvents, and exposure to radiation from ra-

dium, polonium, and radioisotopes. There is
liaison with the U. S. Atomic Energy Com-
mission when the latter inspects licensed
users of AEC material in North Carolina.

The professional engineering staff of the
Occupational Health Service has initiated
survey studies on such matters as x-ray shoe-
fitting machines, x-ray and fluoroscopic ma-
chines used in health departments, hospitals,
and physicians' offices ; on exposure to sol-
vent vapors in the furniture industry; and
on carbon monoxide from heating devices in
motels and tourist cabins. This staff has pro-
vided consultant service on exhaust ventila-
tion for the control of toxic vapors, gases,
fumes, and dusts. Such service has reached
plants in many parts of our state, with much
of it directed to smaller organizations which
did not have ready access to technical
knowledge.

The one area in which the activities of the
Occupational Health Section of the State
Board of Health have not been directly ori-
ented to occupational disease prevention and
control is that of consultation to industrial
nurses. This activity was limited in scope,
time, and geography until the present year.
Until 1958 it was carried on by a nurse
stationed in Asheville who could only devote
part of her time in industrial nursing activi-
ties. Beginning this year, a competent, full-
time nurse is assigned directly to the Occu-
pational Health Section and is giving a wider
coverage to the some 225 industrial nurses
employed in North Carolina, as well as con-
sultation to establishments which are consid-
ering employing a nurse for the benefit of
their employees. This is looked to as a happy
sign of occupational health activities yet to
come.

Limitations and Problems

Within the limitations imposed upon them,
these organizations have served the state ad-
mirably, and have cooperated with one an-
other spontaneously and well. The limita-
tions are not only budgetary ; some are statu-
tory. Many arise from the multitudinous du-
ties imposed on the heads of departments
and divisions, depriving them of time for
thoughtful, creative development of inter-
agency planning in the realm of occupational
health. This has resulted in activities which
are limited and late. This sketchy review in-
dicates that action has been substantially
limited to occupational disease. Even in that
instance It has been late in the sense that

3C0

NUKTH CAROLINA MEDICAL JOURNAL

Septeml>

1960

time and energy spent in prevention are out
of proportion to the time, energy and money
spent in repairing the damage which has al-
ready been inflicted.

The wisdom of prevention rather than cure
becomes more apparent if we translate the
concept into that of a tangible product of
our industry. Such sound management prac-
tices as quality control, preventive mainte-
nance on machinery, and adherence to speci-
fications of raw materials cut down the num-
ber of costly production "lemons." Repair-
ing, recouping, and paying off claims for pro-
duction "lemons" that have found their way
to the market place is a poor investment of
the production dollar. Similarly, however ad-
mirable and needful they may be, payments
for hospital care, rehabilitation, and com-
pensation claims are poor investments of the
health dollar as long as any path of preven-
tion has been left unexplored.

Occupational diseases are the key to the
broad problem of occupational health, for a
well planned, well executed program of oc-
cupational disease control is a stepping stone
to employer and employee understanding and
support of an occupational health service.
As our compensation coverage of occupa-
tional diseases in North Carolina is limited
by a scheduled act, we cannot claim to have
complete information on all these conditions.
For the 26 specific causes and conditions
which are compensable, a review of the 10-
year period from 1946 to 1956 reveals that
the compensation and medical care of victims
of occupational disease is costing from $130,-
000 to $150,000 per year, with the loss of
7,000 to 7,500 working days per year. Sta-
tistical records of the Industrial Commission
show that the dusty trades are not the sole
sources of claims, although the largest sums
for single cases do arise from the mining and
rock-quarrying industries. Among those pay-
ing a heavy toll in lost time and compensa-
tion claims are the cotton, woolen, and hos-
iery mills. The furniture and machinery
manufacturing industries are also frequently
found among the leading five payers of com-
pensation claims and the leading losers of
production days due to occupational diseases.

Analysis of the last five biennial reports of
the Industrial Commission further shows
that our occupational disease cases are
widely scattered by industry types and plant
size, and that agricultural pursuits are not
exempt. A really significant fact is that the
losses clue to occupational diseases are un-

necessary. Our North Carolina organizations
have the professional and technical knowl-
edge and a cadre of professional persons to
deal with the occupational disease problems
in North Carolina industries.

Questions That Merit Consideration

From these rather general remarks con-
cerning the occupational health activities of
our State agencies, several questions may be
drawn which merit the thoughtful considera-
tion of this council: What is needed to make
occupational disease control more effective?
What devices would help to formalize and
insure the coordination of the activities of
the present agencies? Can our teaching hos-
pitals participate in such services as a diag-
nostic clinic for occupational diseases? What
steps are needed to increase the interest of
private physicians in the occurrence of occu-
pational diseases among the breadwinners
of the families they now serve? What forms
of employer and employee education on oc-
cupational disease hazards and their control
are most certain of acceptance and success?

Beyond the matter of occupational disease
control, there is evidence of relatively little
governmental promotion of industry sup-
ported health services. This raises questions
for which answers may be neither quick nor
easy. What steps are needed to encourage
management, workers, and doctors to under-
take a coordinated effort to raise the level
of occupational health in our state? What
increases must be made in the staffs of our
state agencies if they are to exercise leader-
ship and be of practical help, particularly
to our smaller plants? What steps can be
taken to mobilize the potential contributions
which local health departments and com-
munity hospitals are capable of making to
the maintenance of a higher level of health
among the most important person in their
communities — the wage earners?

It is certain that these questions, incom-
plete and poorly framed, have already raised
many new ones in your minds. As these or
others like them are discussed, their com-
plexity should be neither frustrating nor dis-
couraging. They are the daily business of
many of us. They are matters of economic
necessity which must be met by sound man-
agement practices.

Conclusion

It has been demonstrated in the experi-
ences of plants throughout our country, and

September, 1960

MEETING OCCUPATIONAL HEALTH NEEDS— CHANLETT

361

in some in our own state, that well planned
occupational health work will reduce absen-
teeism, reduce insurance costs, and make for
higher morale and more efficient production.
Our Governor has repeatedly expressed his
conviction that occupational health is vital
to the economic progress of our state. The
work of this council will certainly contribute
to our state drive for an increase in indus-
trial plants and for a greater diversification
of our agriculture. A productive occupa-
tional health program will reduce our labor
turnover, and will encourage more of our

best trained workers to stay in North Caro-
lina. This council is the platform upon which
to develop a cooperative effort in occupa-
tional health among employers, employees,
state and local governmental agencies, and
the several professions. Success in such co-
operation is certain to enhance the attrac-
tiveness of North Carolina resources for
capital investors. Our goal is growth.
Healthy and happy workers, sound in body
and in mind, are as vital as dollars in mak-
ing the wheels of production go round and
in making them grow.

Economic Influences of an Industrial Medical Program
On a County Medical Society

Mac Roy Gasque, M.D.

and

Carl S. Plumb, MD.

Pisgah Forest

It is a well known and accepted fact that a
thoughtfully conceived and skillfully ren-
dered industrial medical program can have a
favorable economic impact on such matters
as labor turn-over, absenteeism, and work-
men's compensation insurance premium
rates'1-1. It is less well known but equally
true that such a program can also have an
important economic effect on the private
practice of medicine. In an effort to cast
light on the matter, this essay will offer a
review of a 10-year experience of physician
participation in a company-sponsored Blue
Cross insurance program of a relatively
large industry.

Approximately 11 years ago, this industry
employed its first full-time medical director.
A few months later, equipment, space and
medical staff personnel were acquired.
Thereafter a modern industrial medical pro-
gram was gradually put into effect.
Early Effects

During the first several months rumblings
of a suspicious discontent arose from the
county medical society. Questions of this sort
were asked : "What are you going to do with
all that space and equipment?" "Are you go-
ing to treat workers for their personal ill-
nesses?" "Are you going to take care of em-
ployees' families?" In a climate of mutual

*Medical Director, Olin Mathie^on Chemical Corporation, Pif
gah Forest, N. C.

good will, the members of the county medical
society slowly began to realize that the pri-
mary preventive orientation of the industrial
medical program was a viable reality and
not just a high-sounding statement of policy
gibberish.

Figure 1 shows the number of claims filed
against the company's Blue Cross insurance
plan by physicians in the community. Dur-
ing the early years of the study only three
members of the county medical society were
active in private practice. These physicians
are designated as Doctors A, B and C. It
can be noted that during the first three years
of this study the claims filed by each of these
physicians more than doubled. It is thought
that a large part of this increase in medical
activity was a direct result of the industrial
medical program which, through the medium
of employee meetings, medical films, and so
forth, emphasized the importance of health
and publicized the benefit program. Because
of the growing medical opportunities, begin-
ning in 1953 three additional physicians mi-
grated into the community. They are repre-
sented in figure 1 as Doctors D, E and F.

The total number of claims per year is
shown in figure 2. It is significant that in
1952 the number of claims more than
doubled. It was in this year that the services
of a second full-time industrial physician
were acquired. A program of periodic physi-

362

NORTH CAROLINA MEDICAL JOURNAL

September, 1960

INDIVIDUAL PHYSICIAN PARTICIPATION
TEARS {50—- 59)

P*

m

r *

aad

S3 54 55 54 !
Dr. A

5) 54 55 Si 5' 58 59
Or. B

53 53 54 55 56 37 5B 5? S3 54 33 5* 37

Dr. C Dr. D

» 53 34 53 54 57 || 5*

:>. i

Figure 1

cal examinations for all employees was be-
gun, and a backlog of abnormalities was un-
covered. As a result, literally hundreds of
employees were referred to their personal
physicians for additional diagnostic study
and care.

Although the number of employees re-
mained essentially constant, in 1956 an-
other sharp rise in claims occurred. In this
year two new services were added to the
industrial medical program: (1) an annual
gynocologic survey131; (2) a proctologic
survey of all men over 40. These case-find-
ing programs resulted in many additional
referrals.

These facts and figures give definition to
one type of medical activity which has had
a precise and significant impact on the
economy of a county medical society. More
important is the implication that these fig-
ures provide a faithful index of a general
increase in community medical affairs, re-
sulting primarily from the impetus pro-
vided by an active industrial medical pro-
gram.

Description of Program
It is a fact that many physicians in pri-

vate practice regard industrial medicine as
a somewhat vague, third-party device which
may potentially interfere with their private
practice. In an effort to dispel the wariness
that many feel with regard to the unknown,
there follows a description of the medical
program of the industry referred to in this
study. With certain modifications, this pro-
gram is typical of industrial medical prac-
tice nationwide.

A. Physical examinations

1. Pre-placement physical examinations:
The pre-placement physical examination is
becoming standard in American industry. It
is a multi-purpose procedure, the primary
importance of which is to allow employers
to bring into their organizations workers
with known physical assets. In addition, it
facilitates the skillful placement of workers
with physical limitations. Rejection occa-
sionally is necessary.

In order for a physician to participate ef-
fectively in the placement of workers, it is
mandatory that he have an intimate knowl-
edge of working conditions within the plant.
He must know the demands, both physical,

September, 1960

INDUSTRIAL MEDICAL PROGRAM— GASQUE AND PLUMB

363

Figure 2

emotional and intellectual, of the various
jobs, and he should attempt to calibrate the
assets of the candidate for employment with
the demands of the job.

A pre-placement physical examination can
provide an important base-line of employee
health against which later examinations can
be appraised more skillfully.

2. Periodic physical examinations: Mod-
ern medical thinking is increasingly support-
ing the principle of periodic physical exami-
nations for all persons who have more than
a casual interest in their health. Industry
is taking the lead in this movement. This
development has come about partly because
of the obvious good sense of preserving man-
power. Trained manpower represents indus-
try's most valuable and hard-to-replace asset.
In terms of machinery and equipment, it is a
fact that good maintenance can prevent early
obsolescence and, in some cases, can even
prevent operational failure. The same idea
is equally true when applied to an industrial
worker. Industry has found that it is not
necessary to stand idly by and absorb the
losses of premature failure of manpower'41.
Speaking broadly, health is not a matter of
chance. In fact, a certain and important de-
gree of health is purchasable. Thoughtful
management supports this principle. The
wisdom of the early detection of disease is

apparent to all medically oriented persons.
These ideas underlie industry's interest in
periodic physical examinations.

The techniques of an examination done in
industry are different from those used in
private practice. As a group, industrial
workers come to industrial doctors as well
patients. Their complaints are few. This
puts the onus of responsibility for finding
abnormalities squarely in the doctor's hands.
He needs to be a scientifically oriented as
well as an intuitive diagnostician. The mean-
ing of subtle changes in physiology must be
understood by the physician examining
asymptomatic patients.

3. Special examinations for workers ex-
posed to increased hazards: In most indus-
tries there are work areas of increased haz-
ard, involving such matters as dust, noise,
chemical atmospheric pollution, and chronic
and recurrent psychologic stress. Workers
exposed to hazards of this sort should have
pertinent physical examinations at appro-
priate intervals.

4. Back-to-ivork examinations after ill-
ness: Workers returning to their jobs after
having suffered a significant injury or ill-
ness should be appraised regarding their
ability to return to their usual duties. Some-
times— for example, after disabling injuries
involving the bones and joints — it is neces-
sary for employees to make permanent
changes in their type of work. Occasionally,
after suffering an infectious disease, an em-
ployee will return too soon and while he is
still a source of contagion. Obvious medical
precautions should be enforced.

B. Therapeutic services for

1. Industrially induced illnesses and acci-
dents: A nationwide pattern which provides
definitive therapy for occupational injuries
or diseases is being established. In most
states, workmen's compensation legislation
defines the responsibilities of employers
and the limits of monetary claims by em-
ployees.

2. Personal illnesses and accidents: The
appropriate extent of therapy for personal
illnesses is a little more difficult to define. It
is usual to provide medical care which will
enable an employee to complete his shift or
will provide relief of pain, and to treat minor
conditions which would not take the em-
ployee to his personal physician. When ther-
apy goes beyond this point, it probablv is not
profitable to the industry, and it usually will

364

NORTH CAROLINA MEDICAL JOURNAL

September, 1960

bring the industrial physician into sharp is-
sue with local medical practitioners' ■'". Com-
petition with or replacement of conventional
medical agencies should be scrupulously
avoided. The industrial physician can, how-
ever, render valuable service by providing
counsel and guidance concerning sources of
specialized medical care for personal ill-
nesses.

The part-time industrial physician has a
particularly delicate problem in connection
with the treatment of personal illnesses. He
must be continuously vigilant in order to
avoid using his industrial relationship to
build up a private practice. The principle of
free choice of physician must always be kept
in mind. Except where there is a valid per-
sonal physician relationship with an indus-
trial worker, referrals should be to the office
of the worker's private physician and not to
the office of the part-time industrial physi-
cian. Obviously, in some situations this may
be difficult, especially in very small commu-
nities where the part-time industrial physi-
cian is one of a small number of physicians
residing in the locality.

C. Health education

Health education can take many forms,
and it certainly should include the more
usual, such as distribution of printed ma-
terial, bulletin board posters, group lectures,
and the like. Perhaps the most important
way of educating an industrial population
involves the long and sometimes tedious indi-
vidual doctor-patient contact, as, for exam-
ple, that which takes place at the periodic
physical examination. These examinations
should be carried out in a climate of warmth
and friendliness, and they contribute to pro-
gressive rapport. The ready availability of
a physician who is willing and able to inter-
pret medical questions asked by employees
provides additional opportunity for health
education.

D. Industrial hygiene

The safety of the working environment is
the concern of the industrial hygienist. He
monitors the work areas to determine the
degree and hazard of exposure to chemicals,
radiation, dust, and so forth. Activities re-
lated to industrial hygiene are usually coor-
dinated as a part of the services of the indus-
trial medical department.

E. Medical records

An important part of any medical program
involves good record-keeping, the principal
reasons being: (1) They enable the progress

to be followed of any sick or injured em-
ployee; (2) they provide a basis for adjudi-
cation in cases of compensable injuries; (3)
they enable an objective industrial physician
to appraise the activities of his department
and, when indicated, to modify his program.
F. Special activities

Depending on the intellectual and person-
ality turn of the physician and the industrial
management which he represents, special ac-
tivities can be conceived and carried out.
Typical services provided in this broad cate-
gory are :

1. Preventive immunizations'01.

2. The follow-up of workers with known
or suspected chronic diseases, such as hyper-
tension, obesity or diabetes.

3. Clinical psychology services'7'. Indus-
trial problems involving engineering, produc-
tion, finances or sales are often readily amen-
able to resolution. There is no such ready
resolution of problems involving the ap-
parently increasing number of psychologi-
cally maladjusted and disturbed persons.
The industrial psychologist is gaining status
and increasingly is taking his place as an
important member of the industrial medical
team.

4. Foot care181. Problems involving pain-
ful feet are more frequent than is generally
recognized. While not usually totally disa-
bling, they can be distracting. A skillful
podiatrist can offer an industry a service
which consistently receives a warm recep-
tion.

•5. Proctologic and Gynecologic Surveys'3'.
As a rule, assembly line techniques should
be avoided in industrial practice. However,
in certain types of survey activities, results
justify the means. Part-time or visiting con-
sultants can frequently be integrated into
such surveys.

6. Diabetic detection. This service should
be continuous, and workers who visit the
medical department should be encouraged to
leave a specimen of urine in the clinical lab-
oratory. This affords the opportunity to de-
tect and put under treatment the new dia-
betic patient in the interval between peri-
odic physical examinations.

Conclusion
A program of the sort described in this
paper can be expected to have a very fa-
vorable economic influence on the private
practice of medicine in an industrial com-
munity.

September, 1960

INDUSTRIAL MEDICAL PROGRAM— GASQUE AND PLUMB

365

Traditionally the medical profession has
been concerned with sickness and disease.
The ground rules of industrial medicine al-
low — even require — that doctors concern
themselves with health — the natural history
of health as an entity191. Industrial medicine
is changing the custom of waiting for ana-
tomic and physiologic default. Intervention
in the interest of health promotion is a new
pattern, and it can now be accomplished by
the application of documented techniques of
health education and of early detection and
prevention of disease.

References

1. Casque. M. R.: Occupational Health Pays Dividends.
North Carolina M. J. 18:154-157 (April) 1957.

Hubbard. J. P.: The Early Detection and Prevention of
Disease. New York. The Blakiston Press, 1957.
Casque. M. R., Plumb, C. S.. and DeBord, M.A.: The
"How" of an Industrial Gynecologic Survey, J. Occupa-
tional Med. 2:214 (May) 1960.

Seymour. W. H.: What Industry Needs from the Med-
ical Profession, American Congress of Occupational Medi-
cine, Mexico City, February, 1958.

Wade, L. J.: Needed: A Closer Look at Industrial Med-
ical Programs, Harvard Business Review 34:81 March-
April, 1956.

Committee on Industrial Health Emergencies of the
Council on Industrial Health: Guide for Industrial Im-
munization Programs, J.A.M.A. 171:2097 (Dec. 12), 1959.
Sorkey, H.: Trends in Industrial Psychology. South. M.J.
52:1128-1131 (Sept.) 1959.

Casque, M.R., and Holt, G.F. : An Experiment in In-
dustrial Foot Health. South. M.J. 46:275-278 (March), 1953.
Gasque, M. R. : Trends and Direction in Occupational
Medicine, South. M.J. 62:309-313 (March) 1959.

Compensable Occupational Diseases Under the
North Carolina Workmen's Compensation Act

J. W. Bean*
Raleigh

The North Carolina Industrial Commis-
sion is an administrative agency of the state
which is charged with the responsibility of
administering the North Carolina Work-
men's Compensation Act. The Commission
was created in 1929 by the State Legislature,
and its duties, power, and authorities come
from statute law, as enacted by the Legis-
lature and as interpreted by the Supreme
Court.

The economic theory underlying work-
men's compensation is referred to frequently
as the doctrine of occupational risk.

The history of workmen's compensation
legislation shows that the state legislators
intended to enact compensation laws to cover
these fundamental points :

1. Provide to victims of work accidents
and occupational diseases and their depen-
dents certain prompt and reasonable compen-
sation, plus medical treatment for the worker
for injuries which arose out of and in the
course of his employment.

2. Free the courts from delays, costs, and
tremendous work-load of this mass of per-
sonal injury litigation.

3. Relieve public and private charities of
the fundamental drain caused by uncompen-
sated industrial accidents.

^Chairman, North Carolina Industrial Commission. Raleigh.

Designation of Occupational Diseases

Under the provisions of North Carolina
Workmen's Compensation Act, certain dis-
eases are designated as being occupational
diseases. The Act enumerates 27 causes or
conditions which result in compensable occu-
pational diseases, and defines the Commis-
sion's responsibility for occupational health
in terms of such diseases.

The following diseases and conditions have
been classified as occupational diseases with-
in the meaning of the Act :

1. Anthrax

2. Arsenic poisoning

3. Brass poisoning

4. Zinc poisoning;

5. Manganese poisoning

6. Lead poisoning

7. Mercury poisoning

8. Phosphorus poisoning

9. Poisoning by carbon bisulphide, methanol,
naphtha or volatile halogenated hydrocarbons

10. Chrome ulceration

11. Compressed-air illness

12. Poisoning by benzol, or by nitro and amido
derivatives of benzol (dinitrol-benzol, anilin, and
others)

13. Infection or inflammation of the skin or eyes
or other external contact surfaces or oral or nasal
cavities due to irritating oils, cutting compounds,
chemical dust, liquids, fumes, gases or vapors, and
any other materials or substances

366

NORTH CAROLINA MEDICAL JOURNAL

September, 1960

Table 1

Summary of Occupational Diseases Handled by

The North Carolina Industrial Commission

July 1, 1958, through June 30, 1959

Causes and Diseases

Total No.
of Cases

Total
Compensation

Total
Medical Cost

Total

Days Lop

Anthrax 1

Arsenic 16

Asbestosis _. _. 1

Blisters _... 8

Bone felon 5

Bursitis of elbow.. _ 5

Bursitis over patella 2

Brucellosis I

Carbon bisulphide 3

Carbon dioxide 1

Carbon monoxide 16

Caustics ....

Cellulitis 7

Chlorine _.. 1

Formaldehyde 6

Infection or inflammation to skin or

eyes due to specific substances ._. 258

Lead poisoning 9

Myopia

Nitrobenzol

Occupational neurosis ....

Petroleum distillates 1

Silicosis (16)* 21

Synovitis 28

Wood poisoning 1

Zinc poisoning 1

All other poisoning 13

10

6,000

456

27

45

" 175

680

185
"38

210
393

"263
216
334

81

396

349

5

1,056

12,187
552

209

89

186

21,387
851

23

104
17
23
5
35
36

101

19

2,592
170

120,169
1,216

1,120

20

1,976

1,099

2

63

829

2,231
375

:58

Overall totals (16)

405

$142,860

$30,014

5,998

14. Epitheliomatous cancer or ulceration of the
skin or of the corneal surface of the eye due to tar,
pitch, bitumen, mineral oil, or paraffin, or any com-
pound, product or residue of any of these substances

15. Radium poisoning or injury by x-rays

16. Blisters due to use of tools or appliances in
the employment

17. Bursitis due to intermittent pressure in the
employment

18. Miner's nystagmus

19. Bone felon due to constant or intermittent pres-
sure in employment

20. Synovitis, caused by trauma in employment

21. Tenosynovitis, caused by trauma in employ-
ment

22. Carbon monoxide poisoning

23. Poisoning by sulphuric, hydrochloric or hydro-
fluoric acid

24. Asbestosis

25. Silicosis

26. Psittacosis

27. Undulant fever

Diseases caused by the use of chemicals
shall be termed occupational diseases only
when the employee has been exposed to the
chemicals mentioned above, in his employ-
ment, in such quantities, and with such fre-
quency as to cause the compensable disease.

Coverage

Claims may be made only for diseases re-
sulting from these enumerated causes or
conditions. Complete coverage of all occu-

pational diseases has been the trend in work-
men's compensation laws during recent
years. Eighteen states, including North
Carolina, however, cover only certain enum-
erated diseases. Three states have no pro-
vision whatever in their laws for coverage
of occupational diseases, but full coverage
can be provided for under workmen's com-
pensation law by various methods. One is
by simple definition of the term "injury,"
which in various states has various mean-
ings ; in some states it includes occupational
diseases. In other states full coverage has
been obtained by amending the law and add-
ing other diseases to the schedule listing of
diseases.

A person disabled by occupational disease,
if it arises out of and in the course of his
employment, should be as much entitled to
workmen's compensation benefits as a per-
son disabled by an accidental work injury.
In either case the worker is actually injured,
whether it be from disease or accident, and
in either case the disability has arisen out
of the worker's employment or the environ-
mental condition of his employment.

Claims Filed in North Carolina
for 1958-1959
The following table presents a recapitula-
tion of claims for occupational diseases filed

September, 1960

WORKMEN'S COMPENSATION— BEAN

367

with the Commission during the fiscal year
1958-1959.

Silicosis and asbestosis constitute the ma-
jor cost of occupational disease adjudicated
under the North Carolina Workmen's Com-
pensation Law. However, the incidence of
these diseases is gradually being reduced in
North Carolina as various safety methods
are brought into play and as more interest
is shown by employers and employees in
eliminating dust hazards.

The expanding use of atomic energy for
industrial purposes is resulting in the ex-
posure of more and more workers to the

hazard of ionizing radiation. Provision of
workmen's compensation protection for all
gainfully employed workers who may be ex-
posed to ionization radiation is a problem
which needs serious study, as well as the use
of certain new chemicals in industry. At the
present time no one seems to know just what
would be the best course to pursue in this
respect.

The use of new chemicals and atomic en-
ergy is presenting a new challenge in the
field of occupational diseases, and it will take
the full cooperation of the medical profes-
sion, the employer, the employee, and the
general public to solve this problem.

Radiation Hazards in Industry

Thomas S. Ely, M.D.
Washington, D. C.

Recognition of the harmful effects of ion-
izing radiation occurred shortly after the
discovery of x-ray and radium in 1895. The
acute effects of high doses of x-ray were seen
in 1896 and the carcinogenic effect in 1902.
Although cases of radiation injury have con-
tinued to spot the record since that time, the
potential sources were comparatively small
until the beginning, in 1942, of what has
been called the "Nuclear Age." In the early
forties the vast growth of the nuclear in-
dustry with the Manhattan Engineering Dis-
trict, subsequently to become the Atomic
Energy Commission, involved extremely
large operations — a very rapid expansion —
conducted under Federal Government control
with a very high degree of secrecy. These
factors contributed to the result that the nu-
clear industry grew up with an exceptionally
good record of radiation health control in
contrast to most of the other industrial
hazards, which have been controlled only
after a certain amount of human injury was
experienced. Another result of the unique
beginning has been a certain aura of mystery
surrounding radiation, radiation hazards,
and radiation effects, which persists to a
large extent to the present.

The current operations of the Atomic En-
ergy Commission are carried out mainly un-
der contracts, and involve more than 100,000
employees. Most of them work in large in-

•Assistant Chief, Health Protection Branch. Office of Health
and Safety, U. S. Atomic Energy Commission. Washington
25, D. C.

dustries, each of which has a well staffed
health and safety department.

The Atomic Energy Act of 1954 provided
for a program of radioisotope licenses, which
has greatly expanded the amount of radioac-
tive material that is available to private in-
dustries and individuals not under the com-
prehensive surveillance of the Atomic En-
ergy Commission. The result has been that
smaller installations, much smaller in many
cases, have come into the radiation business.
A more competitive situation often exists
under these conditions, and the result is
sometimes felt by the health protection staffs
involved. The smaller organizations having
licenses necessarily have smaller health
staffs, usually with less training in the spe-
cial field of radiation health. More and more
general practitioners, internists, and sur-
geons have become involved in providing
these services, often on a part-time basis. It
is therefore apparent that there is a need
for greater understanding and education in
the medical field regarding radiation haz-
ards and the treatment of radiation injury.

Effects of Radiation
No medical effect of radiation is unique
from an etiologic standpoint. Some effects,
however, are not often associated with other
causes. Some of the better known harmful
effects of radiation follow.

High dosage

The acute radiation syndrome which fol-
lows a short exposure to a high dose of ex-

368

NORTH CAROLINA MEDICAL JOURNAL

September, 19(50

ternal penetrating radiation of several hun-
dred or more roentgens is well documented
and offers little diagnostic difficulty, partic-
ularly when there is a good history of dosage.
The condition has been seen in patients re-
ceiving radiation therapy, in the Japanese
and Marshallese radiation experience, and
in an occasional industrial accident.

Acute erythema and chronic trophic ef-
fects on the skin following doses of the order
of thousands of roentgens have been known
since shortly following the discovery of the
x-ray.

Some carcinogenic effects of radiation
have been well documented. There were the
leukemias of the early radiologists and of
the Japanese ; the bone sarcomas of the ra-
dium dial painters and of the patients given
radium therapeutically during the thirties;
the skin cancers of the early x-ray workers ;
the liver sarcomas of patients who were
given thorium dioxide as a contrast medium,
and the bronchogenic cancer in miners,
which occurred as early as the middle nine-
teenth century but was not attributed to
radon and its daughters until 1942.

Cataracts have been seen occasionally, par-
ticularly in workers with the earlier cyclo-
tron and other high energy accelerators who
received high doses to their lenses. Tempo-
rary sterility has occurred in cases of high,
acute radiation doses. In all the above cases
the doses have been very high, in the order
of hundreds or thousands of roentgens.

Genetic mutations have been shown to oc-
cur in fruit flies and in mice, and it is prob-
able that a similar effect would occur in a
human population, although it is not likely
to be measurable in any practical human sit-
uation because of statistical limitations. With
regard to the genetic effect, it is the total
dose of radiation to an inbreeding popula-
tion rather than the dose to any segment or
individual that is significant.

In laboratory animals it has been demon-
strated statistically that high doses of radi-
ation have nonspecific life-shortening effects,
but the evidence in studies on human beings
is not conclusive.

Low dosage

All the above effects have resulted from
relatively large doses of radiation. No con-
clusive demonstration of injury from low
doses of ionizing radiation in human beings
has been made as yet. Our estimation of
the effects of low closes, therefore, must be
based on the effects of high doses. Since the

information available is not sufficient to per-
mit the demonstration of the threshold that
exists for most other noxious agents, in gen-
eral the effects of low doses have been esti-
mated on the basis of a linear interpolation
from the effects of high doses, which yields
probably the most pessimistic interpretation.

Standards

Several groups have developed standards
of radiation exposure that are currently in
use in this country. In 1929 an organization
which subsequently became known as the
National Committee on Radiation Protection
and Measurements (NCRP), began develop-
ing standards of exposure based on the haz-
ards of x-ray and radium, which were the
main sources of radiation in those early days.
The committee is an independent group. It
has been expanded and diversified in the in-
tervening years to meet industrial needs, and
has published several handbooks which have
proved useful in the field of radiation pro-
tection. Currently the most widely used are
Handbook 59, which presents standards of
exposure to external radiation"1, and Hand-
book 69, which lists standards of concentra-
tion in air and water for some 240 radioiso-
topes'2'.

The American Standards Association
(ASA) has developed and is developing ra-
diation standards and codes covering several
different phases of the nuclear industry.

In 1959 the President and the Congress es-
tablished the Federal Radiation Council
(FRC), which is a cabinet-level organization
with responsibility to " . . . advise the Presi-
dent with respect to radiation matters, di-
rectly or indirectly affecting health, includ-
ing guidance for all federal agencies in the
formulation of radiation standards and in
the establishment and execution of programs
of cooperation with States ..." Report No.
1 of the FRC was issued on May 13, I960'3'.

These three organizations are not in direct
competition with each other. In general, the
NCRP has developed primary and secondary
standards of exposure on a broad basis, the
ASA has written detailed codes of operation
and measurements, and the FRC has pro-
vided an official basis for the government
use of radiation standards and coordinated
application of standards at the level of fed-
eral agencies.

In general, the values are in agreement.
For external exposure of the whole body to
radiation, the occupational value is 3

September, 1960

RADIATION HAZARDS IN INDUSTRY— ELY

369

Table 1
External Exposure of AEC Radiation Workers, 1958

Dose in Rems

0- 1

1 -2

2-3

3-4

4-5

5-6

6-7

7-8

8-9

9-10
10-11
11-12
12-13
13-14
14-15
15 plus

No. of Employees

59,455

4,041

1,652

407

171

67

31

27

23

11

4

1

3

2

0

12

rems per quarter and an average of 5 rems
per year. For parts of the body or individ-
ual organs, the standard of exposure is gen-
erally higher.

Exposures

The actual exposures to workers in radia-
tion from occupational sources can be seen
in table 1, which is a tabulation of the re-
corded external radiation doses to Atomic
Energy Commission radiation workers for
1958. '

Although this tabulation represents only
one year's record, it is typical of the ex-
posures of other years. It is apparent that
the great majority of the doses were very
low compared to the radiation standards in
effect. All the higher doses resulted from
accidental exposures, and only a few of those
were above the standard of 3 rems per quar-
ter or an average of 5 rems per year.

In table 2 are listed most of the sources
and approximate doses of radiation to which

the average population is exposed currently.
The values were derived from the Federal
Radiation Council Report No. 1.

Although the values are only approximate,
the table serves to show that the dosage to
the main population is coming from essen-
tially two sources. The first is natural radi-
ation, which has existed since the beginning
of mankind. The other is medical x-ray,
which became a factor at the turn of the cen-
tury. It is apparent that such sources as in-
dustrial radiation, fallout, luminous dials,
and television sets comprise only a negli-
gible portion of the total dosage to which the
average population is exposed.

Prevention

The practice of occupational health in ra-
diation industry is almost entirely preven-
tive, very little being curative. Certainly
this represents the desirable trend in occu-
pational health in general, but the radiation
case seems to be in the forefront of the trend.
There have been a total of three accidental
deaths caused by the Manhattan Engineer-
ing District and Atomic Energy Commission
operations, constituting about 1 per cent of
all industrial deaths. Nonfatal radiation in-
juries probably constitute a similarly small
portion of the total injuries. The total inci-
dence of injuries due to radiation and con-
ventional hazards has been better than that
of most other industries.

Thus most of the practice of the industrial
physician in a radiation industry will be con-
ventional occupational medicine. Employees
will continue to fall down, cut themselves, get
burned, and become chemically intoxicated

Table 2

Approximate Average Annual Soft Tissue

Radiation Dose to the Population

Source

Dose in Millirems

Comment

Natural

External

Cosmic rays

32-73

Terrestrial gamma rays

25-75

Internal

Potassium-40

19

Carbon-14

1.6

Radium-226

2-15

Questionable values

Man-made

_,

Medical (exposure to patients)

Diagnostic x-rays

50-100

Therapy

—

Not available

Internal radionuclides

1-10

Questionable values

Occupational

20

High estimate

Environs of medical and industrial

5

High estimate

sources

Fallout

2

Other (luminous dials, TV, etc.)

1-3

370

NORTH CAROLINA .MEDICAL JOURNAL

September, 1960

in almost any industrial setting. The indus-
trial physician's main responsibility regard-
ing the radiation hazard is to assist in the
prevention of injury and of overexposure. A
comparatively frequent task in some circum-
stances may be the decontamination of an
employee — that is, the removal of radioac-
tive material externally or, less frequently,
internally. This procedure is really preven-
tive in nature rather than curative, in that
decontamination prevents the delivery of a
radiation dose.

Diagnosis

The physician in a nuclear industry should
be prepared for and expect occasional radia-
tion injuries, and although the cases on
which to gain experience have been few and
far between, he should be prepared to diag-
nose and treat the injury. He should make
a clear distinction between a radiation dose
and a radiation effect. They are too often
equated. The determination of a radiation
dose is the responsibility of an industrial hy-
gienist or health physicist; the diagnosis of
a radiation effect is a medical responsibility.

Some effects are characteristic enough and
appear promptly enough to make it easy to
determine the cause. After a long latent per-
iod following a low or unknown dose of radi-
ation, however, the diagnosis, may have to
be based on the probabilities of the situation,
many of which are essentially unknown at
the present time. A statement on the diag-
nosis and compensation of radiation injury
by the Radiation Committee and Compensa-
tion Committee of the Industrial Medical As-
sociation may be of interest in this connec-
tion141.

Treatment

There is no specific treatment for radia-
tion injury. This is not to say that there is
no need for specific competence in the field,
but rather that many of the familiar tech-
niques for treating more conventional injur-
ies are equally important in the treatment

of those caused by radiation. The acute radi-
ation syndrome due to exposure of the whole
body is treated basically by the usual symp-
tomatic and supportive measures. In very
serious cases, bone-marrow transfusions
have been tried, but this is still an experi-
mental procedure.

The treatment of radiation burns is not
basically different from that of thermal
burns, and the techniques of the general and
plastic surgeon will be most useful in these
cases. Since the delayed effects of radiation
cannot usually be differentiated from other
conditions, it follows that the treatment
would not be different.

Summary

With the expanding uses and usefulness
of radiation and radioactive materials in in-
dustrial and everyday life, there will be in-
creased need for the services of occupational
health personnel. Injury from radiation is
and should be a vanishing component of in-
jury from all causes, and the practice of radi-
ation health should be limited almost exclu-
sively to prophylaxis. Much of the treatment
of radiation injury is familiar from conven-
tional medical experience, and those in the
medical profession can, with some additional
education in the nature of radiation and radi-
ation hazards, contribute considerably to the
field of industrial radiation health.

References

1. National Bureau of Standards Handbook 59. September
24. 1954 (extended January 8. 1957). For sale by the
Superintendent of Documents, Washington 25, D. C.
Price 35 cents.

2. National Bureau of Standards Handbook 69, June 5, 1959.
For sale by the Superintendent of Documents, Washing-
ton 25. D. C. Price 35 cents.

3. Background Material for the Development of Radiation
Protection Standards, Report No. 1 of the Federal Radia-
tion Council, May 13. 1960. For sale by the Superintendent
of Documents. Washington 25, D. C Price 30 cents.

4. Statement on the Diagnosis and Compensation of Harm-
ful Effects Arising as a Result of Work Involving Ex-
posure to Ionizing Radiation. Statement of the Radiation
Committee and Compensation Committee of the Industrial
Medical Association. J. Occupational Med., in press.

September, 1960

371

Physical Requirements in Textile Manufacturing

Charles G. Gunn, Jr., M.D.*
Winston-Salem

Textile manufacturing has contributed
more to the economic growth of our state
than any other industry. In 1958, the last
year for which we have figures, one fourth
of the gross wages for all North Carolina
industry (manufacturing and non-manu-
facturing combined) was paid to textile
workers. Forty-three per cent of the man-
ufacturing payroll was paid to textile em-
ployees in that year, and the chances of
guessing the occupation of a Tar Heel in-
dustrial worker correctly were 50-50 if you
said, "He's in textiles."'1'

So universal a manufacturing process
affects each of us in our practice of medi-
cine. We care for the health of textile
workers in virtually every county in North
Carolina (fig. 1). Of the 24 counties with-
out textile manufacturing, all but 4 are
adjacent to counties with textile plants.
These non-industrial counties, of course,
contribute commuting employees to the
other counties. It's a sure bet that 96 per
cent of the members of our State Medical
Society have treated at least one textile em-
ployee (or his or her family) in the past
week.

Table 1 lists the types of textile indus-
tries operating in North Carolina in 1958,
with the number of employees'-'.

Table 1
Types of Textile Industries in

North Carolina in 1958
Industry No. Employees

1.

Yarn and thread mills

45,800

2.

Knitting mills

63,765

3.

Narrow woven or braided fabrics

1,859

4.

Broad woven cotton fabrics

68,477

5.

Broad woven cotton,

man-made fiber and silk

23,087

6.

Broad woven wool fabrics

4,528

7.

Dyeing- and finishing textiles

7,276

8.

Apparel and other

finished products

26,514

9.

Floor-covering mills

900

0.

Miscellaneous textile goods

3,417

Total

245,623

♦Medical Director, Hanes Hosiery Mills, Winston-Sa'em,
North Carolina.

It is the purpose of this paper to review
one or two typical operations in each type
of major industry, describing by picture
and exposition the physical requirements
for an employee engaged in each represent-
ative job. Where textile manufacturing
operations are related or similar — for ex-
ample, nos. 3, 4, 5, 6 (table 1) — one pic-
ture and description will be used.

From Yarn to Fabric
Whatever the end product may be (nos.
2 through 10) the first step has to do with
the yarn. This may be vegetable or animal
fiber, or man-made (synthetic). In figure
2 a speeder tender (or roving-frame ten-
der) is operating a machine drawing cotton
sliver into roving, which will be reduced

MONTHLY AVERAGE EMPLOYMENT FOR YEAR 1957

£ C Q C H 2
I 20. 000-J5. 000 |:||||;, 000-4.999

I IOaVO 19.999 I 1 500 I 999

!->:*:j 5.000-9.999 j ^1.499

None - Unshaded

Fig. 1. County distribution of covered employment in textiles. (Courtesy, Employment Security Com-
mission of North Carolina.)

::7L'

PHYSICAL FACTORS IN TEXTILE INDUSTRIES— GUNN September, 1960

Fig. 2. Speeder tender or roving frame tender.

This speeder tender is responsible for four machines, each holding 120 bobbins of roving. He must
constantly inspect for broken ends. He removes, or doffs, the completed bobbin and replaces it with an
empty one. Proper humidity is essential for an efficient operation. Vision, tactile sensibility, freedom of
motion in all joints (for reaching and lifting), and manual dexterity are considered primary in his work.
Note the safe manner in which he carries his pneumatic roll-picker over his shoulder in the cleaning op-
eration.

/y

"DOFFING THE
TAKE -UP PACKAGE.

Fig. 3. Fluflon operator.

This young lady is responsible for the constant observation of more than two thousand heat cans and
their pirns and take-up packages. She must watch for breaks in the yarn. She is walking 50 per cent
of the time. This work requires a high degree of visual accuity, exceptional tactile sense, and a full range
of motion in all joints. Again, humidity plays an important part in the quality of the finished product.
Air conditioning offers a more uniform environment and product, as well as a more efficient employee.
Fluflon, like nylon and dacron is a svnthetic vara.

September, 1960 PHYSICAL FACTORS IN TEXTILE INDUSTRIES— GUNN

373

G

/ COMPLETED
( STOCKING

(POLD DOWN')

<? i

Fig. 4. Knitter.

This knitter walks along an aisle of 30 machines. He is responsible for removing the finished knit
cylinder of the embryo stocking and inspecting it on a board, rolled along as he walks. Note the folding
step to permit adjustments and threading at the top of the machine. Full shoulder and knee motion
is a prerequisite for this operation, as is excellent manual dexterity and a mechanical aptitude. Note the
pans under the machines to retain oil and prevent spread to the aisle.

even more in diameter by a similar opera-
tion before knitting (or weaving) takes
place.

The chemical or thermal treatment of
yarn prior to use gives it unusual charac-
teristics. In figure 3 a fluflon operator is
taking off (doffing) a take-up package up-
on its completion. The yarn has coursed
from the pirn through a heat can while un-
der a fixed amount of twisting and tension
to give it recoil or springy properties, and
upward again to the take-off package.

The two operations that put the yarn or
thread, whether of natural or man-made
fiber, into fabric are either knitting or
weaving or a combination of the two.

Most knitting is of the circular variety —
that is, the knit material forms a cylinder.
The diameter of this cylinder may vary
from y% inch to 36 inches, depending upon
the product being manufactured. In figure
4 a knitter in a seamless hosiery mill can
be seen checking a stocking from a knit-
ting machine. This machine has the same
basic design as one knitting wider and
heavier materials.

Weaving, the major industrial use of
yarns in addition to knitting, can be divided
into broad and narrow woven products. An
example of a broad woven product is bed
sheeting ; of a narrow woven product, cloth
tape.

In either process, the loom must be sup-
plied with warp. In figure 5 a worker is
seen inspecting the transfer of yarn from
hundreds of packages or cheeses, on a rack
called a creel, to the wide cylinder in the
warper called the beam. The beam is then
transferred to the loom (See fig. 6).

The beam furnishes the warp, whether
the loom is a narrow-fabric machine or a
broad loom. In figure 6 a narrow-fabric
machine or loom is seen. The warp ends are
brought up from the beam and down to the
harness, where they emerge to meet the
shuttles carrying the cross threads or fill-
ing ends. The principle involved in the
broad loom is the same. Instead of many
small shuttles and the resulting narrow
tapes, one large shuttle is used, making a
wide roll of cloth, or cut.

374

NORTH CAROLINA MEDICAL JOURNAL

September, 1960

Fig. 5. Warper.

'Phis operator is observing the transfer of yarns
from the creel to the beam in a warper. He must
possess a high degree of visual accuity and depth
perception, an experienced tactile sense to piece
ends together, and a stable back to remain at po-
sitions of slight flexion in performing his work.
(Courtesy, Employment Security Commission of
North Carolina.)

Fin ish ing Operations

We come now to the finishing or com-
pletion operations of the textile product.
One of these, performed by thousands of tex-
tile employees each day, is looping. This is
the closing of the toe in the stockings, men's
socks, children's socks, doll socks, and so
forth, when the sock has been knit as a
cylinder of fabric open at both ends (fig.
4 ) . This work may be done prior to dyeing,
or it may be performed on socks knit with
yarn that is pre-dyed. The looping dial is
built to mate the knitting needle intervals,
and may have points ranging from 12 per
inch to 40 per inch (fig. 7).

Whether fabric for the lining of your
next suit or fabric for your next car or
your child's pajamas, the woven and knit
fabrics must be put in an attractive, useful,
durable form.

Treatment of fabrics by chemicals and
heat play an important role in this condi-
tioning. In finishing mills large vats or
tanks called kiers are filled with hundreds
of feet of woven material. This material
is steeped with chemicals or enzymes for
varying periods of time, then emptied by
power equipment for washing and further

dyeing and finishing
momentary repair of
of a fabric coming
washer.

The final dyeing of
yarns is accomplished

Figure 8 shows the
a break in the strand
from a kier to the

fabrics as well as
by the addition of

r

Finished

WOVEN

NARROW
FABRIC

LOOM ARCH

-HARNESS

Filling ends

FROM QUILLS
ONE TO EACH-'
SHUTTLE

Fig. 6. Weaver.

This man is responsible for three looms. His main activity is walking, moving constantly between the
machines to inspect the operation, repairing ends when breaks occur in both the warp and the filling ends.
Visual acuity of a high degree is essential, as is a normal tactile sense in the fingers. Excellent range
of motion in all joints assures easy operation of the loom. Back flexion is extremely important for the
requirements of reaching the warp ends. Lifting is minimal in this operation. Most weaving does not re-
quire the weaver to remove or doff the finished take-up reel or cut. This operation is assigned to other
employees.

September, 1960 PHYSICAL FACTORS IN TEXTILE INDUSTRIES— GUNN 375

LAMP
fp==J

LOOP

Fi^. 7. Lcoper.

This operation — placing the stocking or sock on its "points" in the only correct position — is extremely
delicate and exacting. The dial revolves (here clockwise) slowly while the fabric is applied. The final
stitching and cutting of the now useless loop from the foot of the stocking is accomplished by mechan-
ical means as it makes its tour around the dial, until the operator removes the stocking, completed, in
front of her.

This work is done in a sitting position. It requires a high degree of visual acuity with an accompany-
ing ability to converge easily (esophoria) and excellent depth perception. Tactile sensibility is of great
importance. Emotional stability must be considered in any list of prerequisites.

MERROvd i]

CO(J WHEELS) J~"

FROM THE

BLEACHING

KIER.

Fig. 8. Kier Boiler.

The textile worker, on the right, a kier boiler, weighs bleaching chemicals and by virture of the opera-
tion, works in an atmosphere of higher humidity and heat than that generally prevailing throughout the
plant. The skin of these workers should be free of recurring infections and free of hypersensitivity to
foreign materials. Strong muscles and a stable back are essential to the effective operation of the lid on
the kier tank and to turning the large valves in the piping system.

dyestuffs to water at high temperatures.
This creates an environment similar to that
of the bleaching operation just described.
Figure 9 shows a piece-dye kettle operator
beside his machine in a broad woven fabric
mill during a dye run.

Comment

Here, in summary, is a view of textile
manufacturing from yarn to finished fab-
ric. No summary would be complete with-

out the final step: apparel manufacturing.
In order to prevent raveling of the cut ma-
terial, an overedger or serger applies, by
machine, a whipped stitch. This operation
is performed before the garment is assem-
bled on a sewing machine (fig. 10).

Summary

A brief description of textile manufac-
turing and the work requirements of repre-

37C

NORTH CAROLINA MEDICAL JOURNAL

September, I960

CYLINDER

^-MOVABLE
I / DOOR.

' 4+UKAPS'

Fig. 9. Piece Dye Kettle Operator.

The taffy-like strands are long segments of 80 yards rolled over a reel and rotated at medium speed
through the dye bathe. The operator is responsible for four machines, for measuring the chemicals
placed in each load, for placing the cloth on the reel, and keeping records of each lot. Note that he is
wearing shoe covers for protection from the moisture normally present in such operations.

Fig. 10. Sergers (Overedgers).

Sergers, or overedgers, overcast the raw edge
of cloth to prevent raveling. This is a job re-
quiring good manipulative ability, agility of hands
and fingers, good visual acuity, and, as with loop-
ing, emotional stability. (Courtesy, Employment
Security Commission of North Carolina.)

sentative jobs in this industry has been pre-
sented. It is hoped that this will create ad-
ditional understanding of the textile indus-
try and of the work performed by our pa-
tients in this industry.

Acknowledgements

Grateful acknowledgement in the preparation of
this paper is to be given to Dr. William Wilson,
Occupational Health Section, State Board of
Health, Raleigh, N. C; Mr. Ted Davis, Employ-
ment Security Commission, Raleigh, N. C; Dr.
J. M. Hall, Elkin, N. C; Dr. Ben Pulliam, Mr.
Arnold Aspden, Mr. C. Zell Taylor and Mr. H. C.
Woodall, Jr., all of Winston-Salem.

References

1. The Employment Security Commission, Quarterly, Winter-
Spring, 1959.

2. North Carolina Employment and Wages 195N, Employ-
ment Security Commission of North Carolina. August,
1959.

September, 1960

The Governor's Council on Occupational Health

A Medium of Cooperative Effort for the Health of the Worker

377

William P. Richardson,
Chapel Hill

.D.

In every period medicine has to face the
problem of a twofold adaptation. On the one
hand it must adjust to changes and develop-
ments in the social and economic order, and
on the other hand it must find new ap-
proaches and methods for making available
new or improved medical services which have
been made possible through scientific and
technological advances. It is customary for
each generation to think its problems and de-
velopments are the greatest of any period of
history, and we in the mid-twentieth century
are no exception. Whether or not this is
really true, it cannot be denied that the pace
of the developments, both social and scien-
tific, to which we must adapt is more rapid
than in previous periods and that it is pick-
ing up speed all the time. With the accele-
rated pace of change it becomes increasingly
difficult and increasingly important to de-
velop sound modes of adaptation which pre-
serve the enduring values and principles that
have always guided our profession.

One of the unique characteristics of the
changes of the past few decades has been
the fact that they brought into the picture of
medical care and medical service not only
many professional workers other than phy-
sicians, but also a variety of agencies and
institutions. This is making it necessary for
the physician to develop a whole new set of
relationships, and to learn to carry out many
of his functions on a cooperative basis with
the various members of what is often called
the "health team," with hospitals, and with
those organizations and agencies which we
have termed third parties.

Occupational health programs, as they
have evolved and continue to evolve, repre-
sent an adaptation to the special needs cre-
ated by expanded industrialization, which
has concentrated workers into large groups
and exposed them to the hazards of increas-
ingly complex technical procedures and a
rapidly growing assortment of new and un-

*Read before the Section on General Practice of Medicine,
Medical Society of the State of North Carolina, Raleigh, May
11, 1960.

From the Department of Preventive Medicine, University of
North Carolina School of Medicine, Chapel Hill.

familiar chemical and physical agents. The
presently accepted pattern of occupational
health programs is an achievement in which
both the medical profession and our indus-
trial society can take genuine pride. Its de-
velopment has not been easy. There have
been difficulties, differences of opinion and
controversy, but after all that is the way
most worthwhile achievements are made. The
significant thing is that we have developed
a philosophy, a set of principles, and a pro-
gram which have met with the official ap-
proval of organized medicine and of the busi-
ness and industrial community, and which,
as understanding of them spreads, are gain-
ing the warm support of the rank and file of
both groups.

The other speakers are dealing with the
way occupational health programs are or-
ganized and operate, and the services they
provide. The feature of these programs I
would like to stress, because it forms the
basis for the whole idea of an occupational
heath council, is the number of individuals
and agencies involved in protecting and pro-
moting the health of the worker, and the re-
sulting importance of close, cooperative rela-
tionships among them, based on principles
and objectives understood and accepted by
all parties of the program.

Growth of the Occupational Health
Movement in North Carolina

Those of us who have been close to de-
velopments in occupational health in North
Carolina feel that significant and heartening
progress has been made over the past several
years. A very important beginning was made
when several able, highly intelligent, and
enthusiastic young men entered this field of
practice in the state, and no account of de-
velopments would be complete without tri-
bute to the splendid contributions these men
have made by their enthusiastic demonstra-
tion and promotion of what constitutes good
occupational health practice and what it can
accomplish.

While the state medical society has had
a committee in the field of industrial
health since 1934, it was primarily con-

378

NORTH CAROLINA MEDICAL JOURNAL

September, 1960

cerned with problems referred to it, in
the main related to the Industrial Com
mission. The first special effort by the so-
ciety to stimulate interest and understanding
in this field was an industrial health seminar
held at Chapel Hill in February, 1954, spon-
sored jointly by the University of North
Carolina School of Medicine and the society's
Committee on Industrial Health under the
leadership of Dr. Harry L. Johnson. This
seminar became an annual event, and in sub-
sequent years was expanded to include a half
day devoted to subjects of interest to repre-
sentatives of business and industry and of-
ficials of state agencies having responsibili-
ties related to industrial health and safety,
as well as to physicians.

Out of these expanded seminars grew the
suggestions for a state conference on occu-
pational health sponsored by Governor
Hodges, and bringing together all who might
have interest or responsibilities in the field :
physicians, nurses, engineers, public health
workers, officials, legislators, and as wide a
representation as possible from business and
industry in the state. The first Governor's
Conference on Occupational Health was held
in January, 1957, and those attending ap-
proved a strong recommendation for a per-
manent council on which all the interested
professions and groups would be represented.
As a result of this recommendation and of
Governor Hodges' interest and support, a
steering group was formed to plan an or-
ganizational meeting and to lay the ground-
work for selection of members. This group
was composed of the Committee on Occupa-
tional Health of the State Medical Society,
representatives of the State Board of Health,
the Department of Labor, the Industrial
Commission, the Vocational Rehabilitation
Division of the Department of Public In-
struction, the University of North Carolina
Schools of Medicine and Public Health, and
two invited representatives from industry.

The preliminary planning took almost a
year and a half. Largely from a list of names
suggested by the steering group. Governor
Hodges asked 42 people to serve on the Coun-
cil. In making the appointments, representa-
tion was provided from the medical, nursing
and engineering professions, from the vari-
ous state agencies concerned, from labor, and
from a cross section of business and industry
in the state, including large and small busi-
ness and all the major industrial and busi-

ness fields. An enthusiastic organizational
meeting was held in July, 1958. The present
membership is 44, including 13 physicians.
This number will be enlarged somewhat in
the near future as a result of action taken
at the last meeting of the Council to add rep-
resentation from the dental profession, the
Department of Agriculture, and the Agricul-
tural Extension Service.

Objectives and Functions of the Council

You will be interested in the objectives of
the Council as stated in the by-laws. These
are:

1. To promote interest in all phases of
employee and worker health in North
Carolina.

2. To provide an effective means for co-
operation and interchange of informa-
mation among all the agencies and
groups interested in the problems.

3. To promote study of special hazards to
employee health which may exist in
North Carolina.

4. To promote the development of practi-
cal programs by which small business
and industrial establishments and ag-
ricultural employers may provide
health services for their employees.

5. To interpret to the officials and citizens
of the state the needs and accomplish-
ments in the occupational health field
in North Carolina.

6. To sponsor an annual Governor's con-
ference on occupational health.

Perhaps the most significant function of
the Council, as distinguished from its over-
all objective of promoting the health of work-
ers, is indicated by the second objective, that
of providing an effective means for coopera-
tion and interchange of information among
all who have a concern for and a part in the
protection and promotion of worker health.
Physicians and nurses, of course, have a tra-
dition of working together, but heretofore
there has been too little opportunity to de-
velop mutual understanding between busi-
ness and industrial management and the
health professions, between physicians and
safety engineers, or between all of these
groups and the several official agencies con-
cerned with industrial health and safety. The
Council supplies a medium where these

September, 1960

OCCUPATIONAL HEALTH COUNCIL— RICHARDSON

379

groups can come together and become fa-
miliar with each other's points of view and
problems and can direct their efforts toward
the development of more effective coopera-
tion in promoting the health of the working
population.

The establishment of such a forum for
communication and exchange of ideas is in
itself a significant development. As society
gets more complex, the problem of commun-
ication between various groups which may
impinge on each other becomes increasingly
difficult. The Council with its broad repre-
sentation provides a forum where thought-
ful consideration can be given to the prob-
lems and ideas of each group, and some mu-
tual understandings achieved. Through the
annual Governor's Conference we have a
broader forum, since the conference is open
to all, and aims for a large and representa-
tive attendance.

Current Projects

Handbook on occupational health

Because the Council is new we have no
completed accomplishments to report, but
two of the projects presently under way are
of particular interest to this group. The first
is a North Carolina handbook on occupa-
tional health. This should be a valuable
source of information for all concerned with
the subject, but especially for physicians do-
ing part-time industrial practice, and for
management, which wants to know what
legal requirements it must meet, to what
sources it can turn for consultation and help,
and what are approved patterns of health
services for employees. It should also be of
significant interest to industrial and business
concerns considering locating in North Caro-
lina. It will, of course, be given wide distri-
bution. Most of the material has been assem-
bled, and it is hoped the completed handbook
will be available by the time the Annual Con-
gress on Industrial Health of the A.M. A,
meets in Charlotte in October.

Services to small plants

The second project is a study of possible
means of providing health services to em-
ployees of establishments too small to have
any kind of full-time service of their own.
Occupational health programs are being de-
veloped by an increasing number of large

industries, but approximately 9 1 per cent of
North Carolina establishments have fewer
than 500 employees, and nearly 80 per cent
have 100 or fewer employees. It is clear,
therefore, that if the majority of our state's
workers are to have the benefits of such serv-
ices, some plan for providing them other
than the conventional in-plant medical de-
partment will have to be devised. It is equally
clear that any effective plan, generally ap-
plied, will involve participation by most of
the general practitioners of the state devot-
ing some time to occupational practice.

As you perhaps know, there are a number
of so-called small plant services which have
attracted considerable attention. We have
had people from some of them talk at our
Governor's Conference. These services are
excellent, and represent imaginative solu-
tions of particular situations. The trouble
is, the establishments they serve, while meas-
ured in hundreds of employees rather than
thousands, are still much larger than those
which constitute the largest segment of our
need in North Carolina. It is worth noting
that the health hazards and problems in
small establishments are proportionately
greater than those in larger ones. Coming
up with a practical approach to this need
is one of the challenges we face, and it is
one to which the Council is addressing itself.

Conclusion

We may summarize this discussion with
four points which I think deserve emphasis :

1. The formation of the Governor's Coun-
cil on Occupational Health is but the most
recent in a succession of developments mark-
ing the growth of appreciation for and in-
terest in employee health services in North
Carolina.

2. The Council offers an excellent medium
for communication and cooperation among
all those concerned with this field.

3. It is inaugurating activities which
should make significant contributions to fur-
ther progress.

4. The ultimate success of the Council and
the solution of the problem of occupational
health services for the majority of our state's
workers will require the understanding, in-
terest, and participation of the practicing
physicians of the state.

::xu

NORTH CAROLINA MEDICAL JOURNAL

September, 1960

Clinical Evaluation of the Antacid Properties
of Hydrated Magnesium Aluminate

David Cayer, M.D.

and

M. Frank Sohmer, M.D.

Winston-Salem

Benign peptic ulcers do not occur in pa-
tients with permanent achlorhydria. In those
patients having active duodenal ulcers, gas-
tric hypersecretion is invariably present.
The relationship between ulcer and acid is
well established, although no definite corre-
lation between the degree of acidity, the se-
verity of ulcer symptoms, and ulcer activity
has been demonstrated. Clinically, antacid
agents provide symptomatic relief.

General Principles of Antacid Therapy

The efficacy of an antacid depends upon
(1) the quantity of acid bound, (2) the
speed of buffering, (3) the duration of ac-
tion, and (4) the rate of gastric emptying.
The effect of acid-neutralizing drugs on gas-
tric secretions is also influenced by (1) the
amount of drug administered, (2) the phase
of digestion, and (3) the presence or ab-
sence of disease.

Free acid, usually defined as being present
at pH levels below 2.8, is considered respon-
sible for the digestive effect of gastric juice.
At pH levels above 2.8 the proteolytic ac-
tivity of pepsin is greatly reduced. A pH
in the range of 3.5 to 5.5 is regarded as
favorable for ulcer healing. Levels above
pH 7 may lead to "rebound" stimulation of
gastric secretion, and are generally consid-
ered undesirable.

The ideal antacid preparation would be
one that is nonirritating and can be used in
small doses to neutralize large amounts of
gastric juice promptly and for prolonged
periods. It should not cause systemic alka-
losis, produce a rebound stimulation of acid
secretion, interfere with digestive processes,
induce diarrhea or constipation, nor release
carbon diovide on reacting with hydrochloric
acid.

Studies of Hi/drated Magnesium Aluminate
We have recently studied a new type of
antacid produced by the chemical union of
aluminum hydroxide and magnesium hydrox-
ide, two of the most widely used antacids.
The resulting compounds, hydrated magne-
sium aluminate*, is a uniform, stable white
powder, which can be prepared both as a
tablet and as a gel.

In vitro studies

In contrast to the previously described
magnesium aluminates in which the ratio of
magnesium to aluminum is always 1 :2, hy-
drated magnesium aluminate has a magne-
sium-aluminum-water ratio of 4:2:9. The
in vitro action of this complex differs mark-
edly from that of equivalent physical mix-
tures of magnesium and aluminum hydrox-
ide, producing more favorable, less scattered
pH values within the therapeutically desired
range of 3.5 to 5.5, and maintaining such
levels for 40 to 60 minutes (fig. 1). The
use of an equivalent physical mixture of mag-
nesium and aluminum hydroxide produces
widely scattered pH values outside the thera-
peutically desirable range, with less sus-
tained buffering action.

The magnesium aluminate hydrate reacts
promptly with gastric hydrochloric acid to
form aluminum hydrochloride gel and mag-
nesium chloride, each with an acid-binding
effect.

The relative acid-combining capacities! of
hydrated magnesium aluminate and other
antacids, in terms of the amount of 0.1 nor-
mal hydrochloric acid neutralized per gram,
are as follows :

U.S. P. aluminum hydroxide (dry gel)
Magnesium aluminate hydrate
Dihydroxy aluminum sodium carbonate
Magnesium trisilicate
Sodium bicarbonate

254 cc.

247 cc.

238 cc.

140 cc.

120 cc.

From the Department of Medicine of the Bowman Gray
School of Medicine of Wake Forest College, Winston-Salem.
North Carolina.

'Supplied as Riopan (400 mg, tablets) through the cour-
tesy of Ayerst Laboratories.

■ Determined by stirring aliquots of the substance with ex-
cess 0.1 normal hydrochloric acid at 37 C. for one hour,
and back titrating the excess acid.

September, 1960 HYDRATED MAGNESIUM ALUMINATE— CAYER AND SOHMER

3S1

Effect of the Maximum Recommended Dosage on the pH of 100 cc N/100 HCI.
(tablets added as an 80 mesh pomder)
70r

7.--*""'

pH 4 0 -j

0 10 20 40

60 90 120

TIME (Seconds)

I. Aluminum hydroxide gel with magnesium hydroxide - 2 Tablets

2. Aluminum hydroxide gel - 2 Tablets

3. Aluminum hydroxide gel (4 grains) and magnesium trisilicate

(71/, groins) - 2 Tablets

4. Magnesium and aluminum hydroxide - 4 Tablevs

5. Reactive aluminum hydroxide - 4 Tablets

6. — Hydraled magnesium aluminate (AY-5710, "RIOPAN'1-400 mg/

tablet -4 Tablets

7. Magnesium trisilicate, calcium carbonate and magnesium

hydroxide - 4 Tablets

6. Calcium carbonate prec, magnesium carbonate and mognesium

trisilicate -4 Tablets

Figure 1

The acid-combining capacity and speed of
action of hydrated magnesium aluminate are
compared with those of other antacids in
figure 1. It can be seen that the hydrated
magnesium aluminate caused a rapid eleva-
tion of pH levels above 3, and sustained buf-
fering capacity.

In vivo studies

Studies of gastric acidity were made on
10 patients — 9 men and 1 woman — with ac-
tive duodenal ulcers. All had evidence of
gastric hypersecretion, and most of the
initial acid values were in the upper range
of normal (figure 2).

In 4 patients who received 2 tablets of
magnesium aluminate hydrate, buffering ac-
tion was demonstrable for 45 to 90 minutes.
Six patients were given 4 tablets in a single
dose. In these patients, a buffering effect
was demonstrable for periods ranging from
30 to 120 minutes.

In 4 patients specimens of gastric secre-
tion were taken 15 minutes after administra-
tion of 2 tablets of the drug. In one patient
no buffering effect was demonstrable, but in
the other 3 achlorhydria was present.

In the majority of patients effective buf-
fering was present for one to two hours. In
those patients having pain at the time the
tablets were administered, relief was prompt
and sustained. The average pH determina-
tions of gastric specimens are shown in
figure 2.

Average

7.0

6.0

5.0
4 0
3.0
2.0
1.0

Ph. Value of Gastric Juice in 10 Peptic Ulcer Patients

Before 400 mq. hydraled magnesium aluminate

After ■' '

o"

/ """^x

is Jri!

s '" >
1 ~

-

1

•

I*

?

i i i i i i

90

15 30 45 60 75

TIME (Minutes)

Figure 2

Clinical study

The clinical study was conducted in 72
patients — 55 men and 17 women — with
symptoms of peptic ulcer. The diagnoses in
this group were as follows: duodenal ulcer
(63), channel ulcer (1), marginal ulcer (3),
duodenal and gastric ulcers (1), duodenitis
(1), normal roentgenogram (2), normal
roentgenogram but with past history of ulcer
(1). The patients ranged in age from 20 to
72 years, with a mean age of 45. Twenty-five
patients had a past history of hemorrhage.
Six patients had previously required surgery
for perforation or obstruction.

Each patient had had peptic ulcer activity
— as indicated by the history, roentgen find-
ings, or both — within six months preceding
the study. Fifty-three of the patients were
considered to have clinically active ulcers at
the beginning of the study. The duration,
frequency, and severity of ulcer symptoms
were determined at the beginning of treat-
ment. The symptoms were considered mild
in 32 patients, moderate in 26, and severe
in 14.

The medication used in the study consisted
of 2 tablets of hydrated magnesium alumi-
nate given two hours after each meal and at
bedtime. All patients were seen at intervals
of four to six weeks, and in the majority
roentgen examinations were made at the be-
ginning and at the termination of the study,
one year later.

Final evaluation of results was based on
data recorded by patients and on the clinical
impression of the investigator at each fol-
low-up visit. The results were classified as

382

NORTH CAROLINA MEDICAL JOURNAL

September, 1960

"good to excellent" (freedom from ulcer dis-
tress throughout the period of observation,
or improvement in spite of recurrence) or
"fair to poor" (exacerbation, no change, or
only slight improvement with continued re-
currences). Recurrences were classified as
"none," "fewer and milder," "same or more."

Results: Seven patients discontinued the
drug — 4 because they were asymptomatic,
and 3 because they were unimproved. Two
other patients had a recurrence of ulcer
symptoms after they ran out of the drug.
The only adverse effect noted was mild con-
stipation in 2 cases. None of the patients
who discontinued the medication considered
side effects a deterrent to therapy.

Forty-nine of the patients (68 per cent)
had good to excellent results (no recur-
rences in 35 per cent, fewer or milder recur-
rences in 33 per cent), while 32 per cent
were unchanged or worse. Two patients had
hemorrhages while under treatment, and 2
required gastric resections.

Comment

lu the clinical study of 72 patients, no evi-
dence of absorption of the hydrated magne-
sium aluminate was noted in any case. There
was no clinical evidence of alkalosis, disturb-

ance of electrolyte balance, severe constipa-
tion, catharsis, or any other significant side

effects.

The preparation was demonstrated both
-'// rira and in vitro to dh o!\ ■ ra idly —
within 15 minutes in human patients. This
compound was able to buffer lai amounts
of gastric acid rapidly, and in most patients
to sustain the pH of the stomach at levels
between 3 and 5 for approximately 60 min-
utes. This buffering effect was manifested
( linically by prompt relief of pain. At no
time did the pH values rise to alkaline levels.

Summary

Clinical and laboratory studies with hy-
drated magnesium aluminate indicate the
compound to be a potent antacid which
rapidly raises the pH of the gastric contents
to therapeutically desired levels, which are
sustained for periods of an hour or more.

In a clinical study of 72 patients with
symptoms of peptic ulcer, no evidence of ab-
sorption, alkalosis, or disturbance of electro-
lyte balance was noted. In the dosage used,
the compound did not interfere with diges-
tion, and produced virtually no side effects.
Results were considered "good to excellent"
in 68 per cent of the cases.

Mail Order Prescription Services

H. C. McAllister*
Chapel Hill

The deceptive lure of "price discounts"
has been the bait with which many a trap
has been set. The latest of these is the mail
order prescription services which have been
springing up here and there during recent
months. The development of these unortho-
dox schemes of supplying medication seems
to have resulted from a series of circum-
stances.

What is believed to be the first plan to
offer prescription service by mail is that de-
veloped by the National Association of Re-
tired Teachers and the American Association
of Retired Persons. These two organizations
worked out an arrangement with a local
New York chain drug store group to set up
outlets for their members. Two mail order

From the Institute of Pharmacy. Chapel Hill.
•Secretary-Treasurer of the North Carolina Board of Phar-
macy.

depots were established — one in Washington,
D. C, and the other in California. The lat-
ter was later closed. (It is understood that
it failed to meet the requirements of the
California law.) Another outlet has been
established by this group in St. Petersburg,
Florida.

As a result of the newspaper headlines
stemming from the reckless and misleading
information (more properly misinforma-
tion) coming out of the Kefauver Commit-
tee hearings, other independent mail order
prescription services have sprung up in Kan-
sas City, Missouri; Brooklyn, New York;
Seagoville, Texas. Another organizational
service (Bakery and Confection Workers
Union) has been established in Washington,
D. C. The last mentioned has already been
in municipal court for a hearing resulting
from alleged failure to comply with pharm-

September, 1960

MAIL ORDER PRESCRIPTION SERVICES— MCALLISTER

383

acy, sanitation, and fire laws. At least one
inquiry has been received by the Board of
Pharmacy concerning' a proposed outlet in
North Carolina. Others will doubtless be es-
tablished in order to capitalize on the favor-
able atmosphere created for them by the
false and misleading information that is cur-
rently being spread abroad about drug prices.

Dangers and Disadvantages

Physicians want to see that their patients
get medication as economically as is consis-
tent with good quality. It is only proper that
they should. Economy, however, is not the
only consideration that must be taken into
account in the treatment of illness by the use
of drugs. The time element and the assur-
ance of proper handling are, in most cases,
considerably more important to the physician
and the patient than the spurious "savings"
(which, if any, are small) that might be of-
fered by the mail order mechanism. From
the standpoint of the physician — and the pa-
tient— the mail order prescription schemes
have some serious disadvantages about which
he — and his patient — should be informed.

Unavoidable delays

The present-day physician is not only bet-
ter equipped to diagnose and prescribe than
ever before, but he also has eminently better
medicinal agents to meet his needs than has
ever been the case in the past. These factors
add up to efficient and effective treatment,
as proved by the dramatic reduction in the
average duration of most illnesses. To
achieve this result, however, the physician
must be able to administer the remedy indi-
cated at the time of diagnosis — not days or
weeks later, when complicating factors may
have intervened, quite possibly altering the
entire rationale of treatment. Allowing for
transportation (both ways), filling, ship-
ping, and so forth, the very minimum time
in which a prescription can be serviced in
Washington, D. C, from a place as near as
North Carolina is three days. Persons who
have used this service place the time element
from ten days to two weeks. One cardiac
patient requested the return of her prescrip-
tion when the medication had not been re-
ceived in two weeks.

Translating the cost of the minimum de-
lay of three days into terms of any savings
that might be effected, it is still false econ-
omy for the patient. Herein lies the "trap"

of the whole mail order scheme. Inherent
in the lure of price discounts for prescrip-
tion service is the idea that traditional pre-
scription services are rendered at a premium
price. It is believed that, in general, physi-
cians consider prescription prices fair. This
is not as well understood, however, by some
of their patients.

A further consideration arising from the
delay in the delivery of the preparation is
the encouragement of self-medication. Pend-
ing arrival of the prescribed drug, the pa-
tient has a strong urge to treat himself. Here
again is introduced an element of interfer-
ence with the physician's plan of treatment

Forged prescriptions

A serious problem encountered with the
supply of drugs through the mails is the
verification of prescriptions. There is no way
whereby prescriptions can be authenticated.
As a test, several forged prescription for
large quantities of barbiturates and central
nervous system stimulants were forwarded
to one of these outlets. In due time the drugs
arrived along with a solicitation of future
business. Such laxity in handling prescrip-
tions and dangerous drugs not only provides
a made-to-order opportunity for deviators to
obtain drugs for illicit traffic, but also can
prove troublesome for the physician in the
management of patients with emotional
problems and others who have the "medicine
habit."

Limited service

With the wide variety of medicinal prep-
arations available today, doctors' prescrip-
tions require less compounding than they did
in former years. There are occasions, how-
ever, when compounding is necessary. Such
prescriptions sent to the mail order outlets
have been returned marked "not stocked."

Suspicion was aroused when it was noted
that the order form of one mail-order outlet
bore an entry for the customer to indicate
whether he wanted his prescription filled
with the organization's "generic equivalent"
of the drug ordered, on the assumption that
this substitute would be cheaper than the
genuine article. This indicates that the mail
order company is willing to substitute its
judgment in determining the brand of drug
supplied for that of the doctor who ordered
it. Evidently this item became troublesome,
since it has now been dropped from the order

384

NORTH CAROLINA MEDICAL JOURNAL

September, I960

form. One continues to wonder, however, if
a specified brand drug will be furnished or
whether the prescription will be filled with a
so-called "generic equivalent" of undeter-
mined origin.

There is yet other evidence of the limited
service performed by the mail order com-
panies. A prescription calling for 30 tablets
of a drug and marked with two refill authori-
zations was filled with the manufacturer's
original bottle of 100 tablets and returned
with the explanation that they were "cheaper
by the hundred."

Inaccessibility of prescription files

What is perhaps one of the most dangerous
aspects of a mail order prescription service
is the inaccessability of prescription files for
use during emergencies resulting from idio-
syncrasies or the accidental ingestion of
drugs by persons other than those for whom
they were prescribed. No one knows better
than the physician how essential it is to
identify the drug that little Johnnie drank
while mother's back was turned. Time is of
the essence in determining whether extreme
measures shall be taken, as in the case of
potent drugs, or whether simple procedures
and assurances to the mother are adequate,
as in the case of the less potent preparations.
Then there is, of course, the occasional ana-
phylactic reaction wherein the identification
of the antigen is essential or will materially
assist in proper treatment.

Question of Legality

There is a serious question as to whether
the mail order distribution of drugs is a legal
operation. Individual states have the right

to exercise police power for the protection
of the health, safety, welfare, and morals of
their citizens. It is through the use of this
power that the health professions are regu-
lated. The states have exclusive jurisdiction
over matters of professional practice and
privilege. Neither the federal government
nor any other extraterritorial body can or
does confer professional license and privilege
upon a person within a state. State laws re-
lating to professional practice and privilege
are administered by specialized boards or
agencies. These boards exercise jurisdiction
only within their own state. Their activities
are designed to protect the people in that
particular state against ignorance and in-
competency. Similarly, a professional license
in one state does not entitle the holder to
practice elsewhere.

This situation poses the question of
whether or not the mail order mechanism
constitutes the practice of pharmacy in
North Carolina. Certainly the Board of
Pharmacy cannot inspect these outlets to de-
termine whether pharmaceutical services are
being performed by qualified persons or
whether other requirements of North Caro-
lina law are being met. The distributors hold
no professional license in the state against
which the Board might proceed, nor are they
available, without extradition proceedings,
for other disciplinary actions as are prac-
titioners in North Carolina against whom the
Board can and does proceed. This aspect
of the problem is currently receiving study
by the Board. Until the question is resolved,
it is believed that physicians will want to
keep in mind the dangers associated with
the mail order schemes, and to advise their
patients accordingly.

The therapist should be a good listener. Even more important, he
should have some knowledge of semantics and should reveal to the pa-
tient that he is interested in what the patient is saying. He should be-
tray it in his manner and his personal expression as well as in what he
says after the patient has expressed his opinion. Remember that a re-
ceptive ear receives the richest harvest. As a listener, the physician in-
creases his knowledge of human nature, and he adds to his own store
of cultural refinements. He will find that in enabling his patient to talk
of interests other than personal aches and worries, he has effected the
best therapv possible. — Martin, A. R. : Recreational Measures and Their
Value to Older People, J. Am. Geriatrics Soc. 7:536 (July) 1959.

September, 1960

EDITORALS

385

North Carolina Medical Journal

Owned and published by

The Medical Society of the State of North Carolina,

under the direction of its Editorial Board.

EDITORIAL BOARD
Wingate M. Johnson, M.D., Winston-Salem

Editor
Miss Louise MacMillan, Winston-Salem

Assistant Editor
Mr. James T. Barnes, Raleigh

Business Manager
Ernest W. Furgurson, M.D., Plymouth
John Borden Graham, M.D., Chapel Hill
G. Westbrook Murphy, M.D., Asheville
William M. Nicholson, M.D., Durham
Robert W. Prichard, M.D., Winston-Salem
Charles W. Styron, M.D., Raleigh

Address manuscripts and communications regarding
editorial matter to the
NORTH CAROLINA MEDICAL JOURNAL
300 South Hawthorne Road, Winston-Salem 7, N. C.
Questions relating to subscription rates, advertis-
ing, ect., should be addressed to the Business
Manager, 203 Capital Club Building, Raleigh, N. C.
All advertisements are accepted subject to the ap-
proval of a screening committee of the State
Journal Advertising Bureau, 510 North Dearborn
Street, Chicago 10, Illinois, and/or by a Committee
of the Editorial Board of the North Carolina Medi-
cal Journal in respect to strictly local advertising
accepted for appearance in the North Carolina
Medical Journal.

Annual subscription, $5.00 Single copies, 75<*

Publication office: Carmichael Printing Co., 1309

Hawthorne Road, S.W., Winston-Salem 1, N. C.

September, 1960

THE NATIONAL ELECTION

Although some of our members feel that
only medical subjects should be discussed
in the editorial columns of this journal, the
editorial board takes the broader view that
doctors need to be well rounded citizens,
and that the inclusion of topics of a gen-
eral nature makes for a greater appeal. The
widespread interest in the Democratic and
Republican Conventions justifies the as-
sumption that some of our readers would
not object to a few impressions of the po-
litical situation from a viewpoint as inde-
pendent and unbiased as human nature will
allow. The views expressed are those of the
editor and do not necessarily reflect the
opinion of the members or officials of the
North Carolina Medical Society.

The nomination of the candidates for the
presidency was for each party a foregone
conclusion. Both successful candidates had
paved the way by long and arduous ground-
work. As James Reston said in his Neiv

York Times column for July 31 : "We have
two efficiency experts as presidential can-
didates."

The choices for the vice presidency, how-
ever, had not been settled in advance of the
political conventions. The selection of Lyn-
don Johnson was a distinct surprise and
somewhat of a shock to many. After the
caustic comments Kennedy and Johnson
had exchanged before the convention, John-
son's selection by Kennedy, and his ready
acceptance, proved anew that politics does
indeed make strange bedfellows.

The selection of Henry Cabot Lodge was
not so surprising. His yeoman service in
the United Nations has made him a recog-
nized authority on our foreign relations.
Parenthetically, when one recalls that his
grandfather took the lead in sabotaging
Woodrow Wilson's League of Nations, the
active role he has played in the United Na-
tions illustrates well John Charles Mc-
Neill's lines:

How teasing truth a thousand faces claim,

As in a broken mirror;

And what a father died for in the flames,

His own son scorns as error.

Just as Kennedy subdued his personal
feelings toward Johnson in order to win his
support, Nixon yielded to Nelson Rocke-
feller's demands for a strong civil rights
plank in the Republican Platform, even at
the cost of breaking away from Eisen-
hower's position and of offending the South-
ern delegates. In exchange, Rockefeller
agreed to give up — for the time at least —
his own presidential ambitions and to nom-
inate Nixon, even though he could not re-
member the middle initial.

As the result of Mr. Nixon's need to pro-
pitiate Mr. Rockefeller, the platforms of the
two parties do not offer the independent
voter too much choice — though the Demo-
crats were decidedly more lavish with
promises than the Republicans. As Senator
Ervin was quoted as saying, however, in an
effort to make the Southern delegates ac-
cept the civil rights plank, "Platforms are
made to run on, not to stand on."

There is still some ground for the opinion
expressed by Dr. John K. Glen in the Texas
State Journal of Medicine for July, 1956 —
that non-voters should not be censured for
staying away from the polls, because there
is not enough difference in the policies of

38ti

NORTH CAROLINA MEDICAL JOURNAL

September, 1960

the two major parties to justify the trouble
of voting: "Therefore, a host of conscien-
tious non-voters is abuilding and becoming
a mighty army. Someone has said, 'What
we don't need in the United States is a third
party. What we do need is a second party.' '

And a recent article in the Saturday Re-
view by Professor and Mrs. Robert Rienow
asserts that many non-voters ai'e so indiffer-
ent and so ignorant of political affairs that
they should not be urged to vote. At least
there is much to be said for a minimum de-
gree of intelligence as a requirement for
voting. This requirement should, of course,
be applied to whites as well as to non-
whites.

We may expect the hardest fought cam-
paign since Herbert Hoover defeated Al
Smith. Both candidates have expressed will-
ingness to accept the offer of free time for
joint debate made by the major broadcast-
ing systems. If rightly used, these debates
should stimulate widespread interest in the
campaign.

It is to be hoped that the contest will not
degenerate into a mud-slinging affair, but
that each candidate may take the high road
instead of the low one. Both men are high-
ly intelligent and articulate and we may ex-
pect each one to present his case forcefully.
Let us hope that each candidate will think
in terms of the welfare of the country in-
stead of the number of the votes he can win
by the stand — or stands — he takes. Let us
hope also that citizens will decide how to
vote after carefully studying the merits of
each candidate and the vital issues ahead,
and may the number of independent voters,
and of the really conscientious non-voters,
continue to increase.

* ^ !;:

SABIN LIVE-VIRUS POLIO
VACCINE APPROVED

After waiting until its use in millions of
people had established its safety, Surgeon
General Burney has approved the general
use of the Sabin attenuated live-virus vac-
cine. Two other live-virus vaccines have
been developed — one by Lederle's Dr.
Herald R. Cox, the other by Dr. Hilary Ko-
prowski of the Wistar Institute in Phila-
delphia. As yet, the one developed by Dr.
Albert B. Sabin of Cincinnati is the only
one approved.

The acceptance of a live-virus vaccine for
immunization against polio is good news for
doctors, parents, and children. There is no

doubt but that the live virus confers a more
lasting, perhaps a permanent, immunity
against polio, and the fact that it is taken
by mouth in a pleasant tasting vehicle
makes it far more acceptable to children,
and also to adults, than the hypodermic
needle method.

Although the Sabin vaccine has been ap-
proved, it will be some time yet before the
manufacturers have produced enough to
make it available for general use, and it is
not yet certain how it will be distributed.
The United States Public Health Committee
on Live-Virus Vaccines believes that the
most effective way to eradicate polio would
be to give the vaccine in mass vaccination
programs rather than in the unsaturated
contact by private practitioners. This
method was used in Russia and other for-
eign countries with very favorable results
reported. The committee also recommended
that the vaccination program should be
continued year after year.

The problem of finding the best way to
distribute the live-virus vaccine will re-
quire cooperation between private physi-
cians and the Public Health worker. It does
not seem too much to hope that the univer-
sal use of this type of vaccine may mean
that before too long paralytic polio may be
as rare as is typhoid now.

ABOLISH AGE DISCRIMINATION
IN EMPLOYMENT?

Senator Pat McNamara deserves com-
mendation for introducing, on June 22, a
bill (S.3726) to abolish age discrimination
in employment under federal contracts. In
introducing the bill. Senator McNamara
said in part:

We have listened to the direct testimony of
jobseekers under the age we usually think of as
"old,'' and have studied reports about discrim-
ination in employment against men and women
of 40 — even as young as 30 and 35 in some
cases . . .

We have adequate scientific evidence now that
age by itself — especially for the group I have
reference to, under 65 — is absolutely no basis
for deciding whether or not to hire a new worker
or replace an older employee . . .

Even in times of full employment — when labor
is scarce — the practice of age discrimination in
employm3nt exists . . .

It is more and more important that we broad-
cast the facts about the argument that higher
pension costs are the real obstacle to hiring
older woi kers. The Department of Labor's stud-

September, 1960

EDITORALS

387

ies of this type of argument have concluded that
such costs need not stand in the way of a sound
policy of hiring- on the basis of a person's actual
ability to do the job — and not his or her age.

The bill I am introducing (S.3726)— with the
co-sponsorship of Senators Clark and Randolph —
will be a major step toward reducing this shame-
ful and unnecessary practice.

It would show that the Government itself is
practicing what it preaches — by requiring that
all its contracts with furnishers of goods and
services adopt personnel policies on the basis
not of age — but of a person's actual physical
and mental abilities to perform his work — on the
basis of his personal merits — and not how long-
ago he was born.

This bill also requires that the Secretary of
Labor organize and conduct labor-management
conferences for the purpose of implementing- and
distributing information about the policy of the
Act.

S.3726, if passed, should do much to en-
courage the continued usefulness and self-
respect of many now forbidden gainful em-
ployment because they are past the 40-year
mark.

North Carolina has been a pioneer in
crusading for fair age-employment policies.
In his address to the State Conference on
Aging, Governor Hodges made a vigorous
protest against turning people out to pas-
ture merely because they have reached a
certain age. And long before that he had
endorsed a brochure entitled "A New Look
at the Mature Worker," published by the
Governor's Coordinating Committee on Ag-
ing. This brochure anticipated the reason-
ing of Senator McNamara's bill.

OCCUPATIONAL HEALTH ISSUE

Industrial — or occupational — health has
become a career that is attracting more and
more physicians. Next month North Caro-
lina will for the first time be host to the
A.M. A. Congress on Industrial Health, to
be held in Charlotte October 1-12.

In anticipation of this important event
this issue of the North Carolina Medical
Journal contains a collection of papers on
various phases of occupational health. It
will be noted that the relation of the pri-
vate practitioner to this special field is
stressed. These papers constitute a valuable
source of information on an increasingly
important subject.

THE SPEEDING AMBULANCE

A number of editorials have been written
in this and other journals on the menace of
the speeding ambulance. A recent news
story, however, of an ambulance wrecked
while conveying to the hospital the victim
of another wreck gives an occasion for one
more protest. The only real reason for an
ambulance to speed through town with the
siren wide open and flashing red lights is
the advertising feature. Someone has said
that it would be just as effective advertis-
ing and safer for the passenger patients if
ambulances were equipped with sound de-
vices to proclaim at frequent intervals,
"This is X's ambulance!"

It is pertinent to quote again from an
article in the Journal of the Michigan State
Medical Society (September, 1957) by Drs.
George J. Curry and Sydney N. Lyttle : "An
ambulance averaging 30 miles per hour
would require 10 minutes to travel 5 miles.
To save 5 minutes, 60 miles per hour would
be necessary. In 2,500 consecutive ambu-
lance runs, this time-interval would not
have influenced the course of a single in-
jury." The authors added, however, that 36
victims were in severe shock upon arrival
at the hospital and that "The degree of
shock may have been increased by a rough
ride in an ambulance."

Is it not time for some legal restrictions
to be put upon the ambulance?

MAIL ORDER PRESCRIPTIONS

At the Miami Beach Meeting of the
A.M. A. a resolution was unanimously
adopted condemning prescriptions by mail
order except when no other way was avail-
able. In this issue Mr. H. C. McAllister,
Secretary-Treasurer of the North Carolina
Board of Pharmacy, gives clear-cut and log-
ical arguments against the prescription
service by mail now being offered by many
out of state concerns. Every doctor should
read this article and learn from it how to
advise his patients not to risk their health
by falling for the lure of "price discounts."
The doctor and the pharmacist should work
together as a team for the benefit of the
patient — and this teamwork is not possible
when the pharmacist is far off in another
state.

388

NORTH CAROLINA MEDICAL JOURNAL

September, 19fi0

President's Message

As conscientious and ethical American
practitioners of medicine, our primary mo-
tivation must always be to initiate and sup-
port those qualities of medical care which
are productive for the best interests of the
people of this Nation. However, the instinct
of self-preservation, being perhaps the
strongest instinct with which humans are
endowed, motivates us as physicians, just
as other organized groups in society are
motivated, to advocate and support those
principles which are favorable to the pro-
fession, provided they be compatible with
the best interests and well-being of our peo-
ple.

Controversy relates very closely to moti-
vation and quite often, in extremes, pro-
vides an overflow of bitterness. Currently,
there is tremendous awareness, controver-
sy, and some bitterness concerned with the
phenomenon of medical care within our
United States. Our citizenry is currently di-
vided into two over-all groups who have a
basic divergence of opinion as to what is
best for the health and well-being of our
people, specifically with regard to the pro-
vision of medical care on a national level.

On the one side are those, motivated by
socialistic urges and political expediency,
who advocate medical care as a service of
the Federal Government. This group, in ef-
fect, has already altered our Bill of Rights
to include, in addition to the rights to "Life,
Liberty, and the Pursuit of Happiness," the
right to share the national wealth by tax-
ation ; the right of labor to strike and bar-
gain collectively; Social Security; support
and regulation for agriculture and business.
Now these people would add the right to
total medical care as a function and service
of the Federal Government. This last right
is to be furnished regardless of the indi-
vidual's ability or desire to provide such
service for himself.

All physicians hold the opinion that
everyone is entitled to medical care. We be-
lieve, however, that the provision of this
commodity, in its entirety for all people, is
not rightfully a function of the Federal
Government. In accord with physicians in
this belief is an equally large, better in-
formed, and better educated, properly moti-
vated segment of American society. This
group believes and can document the fact

that socialized medicine is synonymous with
inferior medical care and stagnation of
medical progress through research. It is
basic that a competitive spirit is yet re-
garded as essential to the vigor and quality
of medical research and the excellence of
medical care, because, as ever, it is the
principal source of incentive and motiva-
tion.

Recently, a large group of business, farm,
and professional people in this country pre-
vailed upon a coalition of Northern Repub-
licans and conservative Southern Democra-
tic Senators to defeat a bill before the Sen-
ate designed to initiate the socialization of
medicine. This bill embodied the principle
of government relative to medical care as
set out by the Platform of the National
Democratic Party. This legislation was en-
thusiastically supported by the Democratic
candidates for the Presidency and Vice
Presidency, Senators Kennedy and Johnson.
More adamant in support of this legislation
were the leaders of organized labor and
labor unions.

Fortunately, North Carolina has in its
two Senators men of understanding char-
acter who possess the ability to analyze and
understand this type of proposed legisla-
tion. Senators Ervin and Jordan are also
men of stability and conviction, who pos-
sess the fortitude to vote their sincere con-
victions regardless of party affiliation. Both
of our Senators strongly advocated the de-
feat of this bill designed to provide total
Federal medical care to all recipients of
Social Security. These men knew this bill
for what it was and recognized that it
would reflect to the detriment of our people.

Senators Jordan and Ervin did support
and help pass a bill which meets, head on,
the problem of governmental assistance in
the provision of medical care for the needy
and near needy. Realistically, this bill,
which was supported by medicine, provides
for financial participation and administra-
tion at state and local levels.

Physicians as a group or as individuals
can no longer afford to hold aloof from the
social, economic, or political facts of life.
There is no longer room in medicine for
cynicism and indifference as applied to the
basic concepts of medicine as a free enter-

September, 1960

PRESIDENT'S MESSAGE

389

prise system productive of the best medical
care known to the world. There are those
prevalent and active who would make of
our profession a trade; of our medical
academies, trade schools ; of the Federal
Government, our employers, and of our
standards of excellence, monotonous medi-
ocrity. Medicine must tighten its ranks and
protect vigorously those things which we
hold to be inalienable to high quality med-
ical care.

May I urge that all physicians commence
now to give generously of themselves as
well as of their possessions to support those
in government and politics who uphold the
principles of quality medical care for our
people. It is essential, but not enough, to
give your money to support our friends in
government. Giving one's self, one's time,
one's effort, and one's personal influence is
real giving. Medicine has the potential. No
group in North Carolina has the personal
contacts, the opportunity, and the ability
to influence the thinking of our people, to
the well-being of all concerned, as do North
Carolina's physicians. It is imperative that
we take a few minutes each day with each
contact to exercise this prerogative.

One Southern Senator, name unidentified,
who recently supported conservative med-
ical legislation gave as his reason for such
action the fact that he had three thousand
doctors in his state on his side. He further
stated that he knew of no other group of
three thousand persons whom he would
rather have on his side. There is reason to
believe that this was the statement of a
North Carolina Senator. Let us not let him
down.

Amos N. Johnson, M.D.

BULLETIN BOARD

COMING MEETINGS

State

Ninth District Medical Society Symposium —
Moose Lodge, Morganton, September 29.

North Carolina Fifth District Medical Society
meeting — Mid Pines Club, Pinehurst, October 5.

North Carolina Society for Crippled Children
and Adults, Twenty-fifth Annual Meeting — Wash-
ington-Duke Hotel, Durham, October 6-8.

Eleventh Annual Winston-Salem Heart Sympo-
sium— Robert E. Lee Hotel, Winston-Salem, Octo-
ber 7.

North Carolina Board of Medical Examiners, in-
terviews with candidates for license by endorse-
ment— Virginia Dare Hotel, Elizabeth City, Octo-
ber 7.

Blue Shield Plans, Annual Program Conference
—Drake Hotel, Chicago, October 10-11.

A.M.A.'s Twentieth Annual Conference on In-
dustrial Health— Charlotte, October 10-12

Seventh District Medical Society, Annual Meet-
ing— Gaston Country Club, Gastonia, October 19.

Duke University Postgraduate Medical Seminar
Cruise to the West Indies — November 9-18.

Ninth Annual Gaston Memorial Hospital Sym-
posium— Masonic Temple, Gastonia, November 17.

North Carolina Academy of General Practice,
Annual Meeting — Carolina Hotel, Pinehurst, No-
vember 27-30.

Regional and National

A.M.A.'s First Regional Conference on Rural
Health (Southeastern states) — Dinkier-Plaza Hotel,
Atlanta, Georgia, October 7-8.

American College of Surgeons, Forty-sixth An-
nual Clinical Congress — San Francisco, October
10-14.

American Rhinologic Society, Sixth Annual
Meeting — Belmont Hotel, Chicago, October 8.

Winston- Salem

•••ia D Greensboro

•• • •

• *Q Raleigh

•••

• •

•••

MATERNAL DEATHS REPORTED IN NORTH CAROLINA^
SINCE JANUARY I, I960

Each dot represents one death

Washington,^ v£>

* r

Wilmington,./

:!!iii

NORTH CAROLINA MEDICAL JOURNAL

September, 1960

American Heart Association, Annual Meeting —
St. Louis, October 21-22.

Southeastern Allergy Association, Fifty-fourth
Annual Meeting — Atlanta Biltmore Hotel, Atlanta,
October 21-22.

Southern Chapter, American College of Chest
Physicians, Seventeenth Annual Meeting — Statler-
Hilton Hotel, St. Louis, October 30-31.

Southern Medical Association, Annual Meeting
— St. Louis, October 31-November 3.

Sixty-seventh Annual Convention of Military
Surgeons — Washington, D. C, October 31-Novem-
ber 2.

American Medical Writers' Association — Morri-
son Hotel, Chicago, November 18-19.

Southeastern Region of the College of American
Pathologists and the Virginia Society of Patholo-
gists: Seminar on Kidney Diseases — John Marshall
Hotel, Richmond, Virg-inia, November 25-26.

Emory University Postgraduate Course in Oph-
thalmic Surgery — Grady Memorial Hospital, Atlan-
ta, December 1-2.

New Members of the State Society

The following physicians joined the Medical So-
ciety of the State of North Carolina during the
month of August, 1960:

Dr. Claudia Gertrude Oxner, St. Joseph's Hos-
pital, Asheville; Dr. Luman Harris Tenney, Route
1, Arden; Dr. John Thomas Dayton, 3800 N. Inde-
pendence Blvd., Charlotte 5; Dr. Charles Otis
Chrysler, 3800 N. Independence Blvd., Charlotte;
Dr. William Joseph Callison, 108 Doctors Building,
Asheville; Dr. Robert Earl Nolan, O'Hanlon Build-
ing, Winston-Salem; Dr. Henning Frederick
Adickes, Jr., 2832 Selwyn Avenue, Charlotte; Dr.
Julian Barker, 1012 Kings Drive, Charlotte; Dr.
Hugh Harrison Hayes, Jr., 3212 Country Club
Drive, Charlotte; Dr. William Malcolm Eubanks,
Jr., 4200 Park Road, Charlotte; Dr. Cecil Lawrence
Johnston, 1616 Palm St., Goldsboro.

News Notes from the Bowman Gray
School of Medicine

Dr. Isadore Meschan, professor of radiology and
chairman of the Department of Radiology, has
been awarded a cancer related research training
grant (radiation biology) by the National Cancer
Institute of the National Institutes of Health. The
grant is in the amount of $365,000 for a period of
three years and nine months.

The training program will be sponsored through
the Department of Radiology, and will be under
the direction of Dr. Donald J. Pizzarello. The pro-
gram was activated on September 1, 1960, and it
is anticipated that the first trainees will be ap-
pointed for a January term.

In addition to his duties as director of the radi-
ation biology training program, Dr. Pizzarello will
also serve as a member of the teaching staff. He
holds the bachelor of arts, master of science and

doctor of philosophy degrees from Fordham Uni-
versity, New York City. For the past year he has
been a research fellow at the Argonne National
Laboratory, Division of Biological and Medical Re-
search, Argonne, Illinois.

In addition, 14 research grants from the U. S.
Public Health Service, totaling $266,453 for the
coming year, were awarded to the Bowman Gray
School of Medicine during the month of August.
Among the largest was a $50,000 award to Dr.
Richard L Burt for "Studies on Carbohydrate
Metabolism in Pregnancy" and $43,025 to Dr. Nor-
man M. Sulkin for "Ultrastructure of Nerve Cells
in Experimental Aging." In the latter grant, funds
are approved for the purchase of an electron micro-
scope. Dr. Robert W. Prichard and Dr. Martin G.
Netsky were awarded $29,440 for "Studies on
Spontaneous Atherosclerosis," and Dr. Harold D.
Green received approval of a grant for "Inter-re-
lation of Venous Return and Vasomotor Tone."

* # *

Dr. Eben Alexander, Jr., professor of neurosur-
gery, has been appointed to the editorial board of
the Journal of Neurosurgery. The appointment is
effective January 1, 1961.

Dr. Walter J. Bo, a native of Minnesota, has
joined the faculty as associate professor of anato-
my. Previously, Dr. Bo was associate professor of
anatomy at the University of North Dakota School
of Medicine at Grand Forks, North Dakota.

A graduate of Marquette University, Dr. Bo
also received a master of science degree in zoology
from that school. He holds a doctor of philosophy
degree from the University of Cincinnati School
of Medicine Graduate School.

He has been an instructor in zoology at Xavier
University at Cincinnati, a teaching fellow in his-
tology at the University of Cincinnati, a cancer re-
search fellow at the University of Cincinnati, and
assistant professor of anatomy at the University of
North Dakota Medical School.

* * *

Dr. Alanson Hinman, assistant professor of pe-
diatric enurology, has returned from a three year
leave of absence. During his leave, Dr. Hinman
served as a special clinical trainee in neurology at
Columbia University, College of Physicians and
Surgeons, New York City.

Dr. Richard C. Proctor, associate professor of
psychiatry, has been named chairman of the De-
partment of Psychiatry.

Dr. Angus Randolph, associate professor of psy-
chiatry, has served as acting chairman of the de-
partment since 1956. He will continue as a member
of the full-time faculty.

Dr. Proctor graduated from Wake Forest Col-
lege in 1942 and from Bowman Gray School of
Medicine in 1945. He served an internship and resi-
dency at the U. S. Naval Hospital, Bremerton,

September, 1960

BULLETIN BOARD

391

Washington; the N. S. Naval Hospital, Great
Lakes, Illinois; and at Graylyn. He joined the
Bowman Gray faculty in July, 1950.

He has served as secretary-treasurer of the
Southern Psychiatric Association and president of
the Day Care Nursing Association. He is a mem-
ber of the American Psychiatric Association, the
North Carolina Medical Society, the Forsyth
County Medical Society, the Southern Medical As-
sociation, and the Tri-State Medical Society.

From 1950 to 1952, Dr. Proctor served as assist-
ant director of Graylyn. In January, 1959, he
moved his office from Graylyn to the Bowman
Gray School of Medicine, where he continues as a
full-time member of the faculty.

Dr. James B. Wray, instructor in orthopaedics,
will assume his new duties as chairman of the
Section on Orthopaedics at the State Medical Uni-
versity of New York, Upstate Medical Center, Syr-
acuse, New York, on October 1, 1960.

Dr. Wray has served as a member of the Bow-
man Gray faculty since July, 1957.

News Notes from the Duke University
Medical Center

As announced earlier, the Duke University Med-
ical School is sponsoring a postgraduate Medical
Seminar Cruise to the West Indies this fall aboard
the new Kungsholm, Sweden's largest transatlantic
liner and cruise ship. The luxury ship, which will
sail from New York City on November 9, will
visit the Virgin Islands and San Juan, Puerto Rico,
and will return to New York on November 18.

Shipboard lectures on various subjects in medi-
cine, pediatrics and surgery will be given by the
following members of the Duke Medical School
faculty: Dr. Edwin P. Alyea, professor of urology;
Dr. Doris Ahlee Howell, associate professor of
pediatrics and pediatric hematologist; Dr. William
M. Nicholson, professor of medicine and assistant
dean for Postgraduate Medical Education; Dr. El-
bert L. Persons, professor of medicine; and Dr.
William M. Shingleton, professor of surgery.

The instructional program will provide 20 hours
credit toward postgraduate requirements of the
American Academy of General Practice. While
designed primarily for the generalist, the program
should be of value and interest to the specialist.
Informal panel discussions, clinicopathologic con-
ferences, and formal presentations will be given
by members of the faculty.

A Duke University medical scientists is ap-
proaching the study of strokes through observa-
tion of blood vessels inside the eyeball.

Dr. Albert Heyman, working under a $2,000
grant from the Wilson County Heart Association,
is utilizing new techniques for diagnosing abnor-
malities in the brain's circulatory system and also
for gaining more information about strokes. He

plans to study the retinal blood vessels by photo-
graphing them with specially adapted "eye ground"
cameras, by making motion pictures, and by meas-
uring blood pressure inside these vessels.

Dr. Heyman is an associate professor of medicine
at the Duke Medical Center. Working- with him in
the research project is Dr. Regina Frayser, in-
structor in medicine. They will be assisted by
photographers in the medical illustration depart-
ments of Duke Hospital and the Veterans Admin-
istration Hospital here.

A new radiation therapy and research division
has just been completed at the Duke University
Medical Center and is now in use.

Providing extensive facilities for radiation treat-
ment of cancer, the division is housed in a $375,000
addition to Duke Hospital that has been under
construction for the past year.

A "cobalt 60" therapy unit, one of several in
North Carolina, provides radiation dosage equiva-
lent to that of a three million volt x-ray machine
for treatment of deep-seated cancer.

A "cesium 137" unit represents the latest devel-
opment in supervoltage radiation therapy equip-
ment. Small and compact, this unit produces a
beam similar in many ways to that of a one mil-
lion volt x-ray machine requiring a two-story space
for installation. The cesium unit is onn of a few
now in use in the United States.

An appointment and a promotion in the admin-
istrative staff of Duke Hospital were announced
recently by Charles H. Frenzel, hospital superin-
tendent.

James W. Anderson has joined the staff as bus-
iness officer, succeeding Leonard E. Small.

John A. Salmon, Jr., has been promoted from
assistant collections officer to admitting officer, suc-
ceeding Mrs. Elizabeth Hendricks.

A six-year research project aimed at producing
better nurses has been initiated at Duke Univer-
sity. The study is being conducted jointly by the
University's Department of Sociology and Anthro-
pology and the School of Nursing.

Dr. John C. McKinney, sociology, department
chairman and principal investigator for the pro-
ject, said that "in effect, we are studying the for-
mation of nursing students' professional goals and
attitudes during the course of their education."

News Notes from the University
of North Carolina School of Medicine

North Carolina Memorial Hospital of the Uni-
versity of North Carolina received its one hundred
thousandth patient recently.

The number 100,000 was marked by the name of
Mrs. Katie B. Koch of Bailey, a Nash County com-
munity. Mrs. Koch, a housewife, was treated in the
Out-patient Clinic of the hospital.

From a few hundred patients seen in this clinic
the year the hospital opened — 1952 — the number

392

NORTH CAROLINA MEDICAL JOURNAL

September, I960

during the past 12 months has grown to nearly
60,000.

The hospital observed the eighth anniversary of
its opening on September 2.

* * *

Dr. Charles H. Burnett, head of the Department
of Medicine, has been granted a year's leave of
absence for research work at the University of
London. During his absence, the department will
be headed by Dr. Louis G. Welt, professor of medi-
cine.

Dr. Robert R. Cadmus, director, and E. B. Craw-
ford, Jr., assistant director of North Carolina
Memorial Hospital, flew to Panama City, Panama,
recently for consultation with officials of a new
hospital under construction there.

Memorial Hospital has had a contract to assist
the Panamanian hospital since the project first got
underway about two years ago. The new hospital
is expected to open in a year.

Experiments have been conducted with a new
instrument at the University of North Carolina
School of Medicine which has successfully meas-
ured the oxygen in the brain of a living animal

The project was canned out by three anesthe-
siologists of the Department of Surgery. Dr. Ken-
neth Sugioka was the principal investigator. He
was assisted by Drs. David Davis and Rodney Mc-
Knight,

An account of this research was given August
24 at the Stanford University Medical Center at
Palo Alto, California, before the annual meeting
of the American Physiological Society.

Prior to the development of this instrument,
exact measurement of oxygen in tissue had not
been possible.

Dr. Charles E. Flowers, Jr., associate professor
of obstetrics and gynecology, went to the Univer-
sity of California recently to establish a special
study of "Diabetes in Pregnancy" for the Ameri-
can Medical Association.

* * *

A $2 million request to help launch construction
of a long range health center addition at North
Carolina Memorial Hospital was included in the
university's $15.3 million capital improvements
budget request presented recently to the state's
Advisory Budget Commission.

Also included in the total $3,459,000 budget re-
quest for the Division of Health Affairs for the
coming biennium is a $1,434,000 appropriation to
provide complete air conditioning for Memorial
Hospital and the School of Dentistry. Another
$25,000 is earmarked for renovation of certain
areas in the medical school.

The health center addition would be the first
stage in a 10-year physical expansion program
which might cost upwards of $8 million.

The University of North Carolina is getting a
$30,000 gift from the will of Mrs. Elva Bryan Mc-
Iver of Sanford.

The Council of State has formally accepted a 47-
acre tract of land valued at $30,000 which Mrs.
Mclver willed to be used to establish a loan fund
for medical students at the university.

The gift was left in memory of Mrs. Mclver's

husband, the late Dr. Lynn Mclver.

* * *

A new training program for persons engaged in
the care of the mentally ill is being organized by
the North Carolina State Hospitals Board of Con-
trol.

Dr. Charles R. Vernon of the Department of
Psychiatry, U.N.C. School of Medicine, has been
named director.

Dr. Kendall Owen Smith, who has made signifi-
cant contributions to the knowledge of how vir-
uses invade living tissue cells in research utilizing
an electron microscope at the U.N.C. School of
Medicine, has accepted a position at Baylor Uni-
versity in Houston, Texas.

Dr. Smith, a Ph.D. graduate in bacteriology in
the U.N.C. medical school and a native of Wilson,
has been since August, 1959, a postdoctorate train-
ee of the U. S. Public Health Service, working
with Dr. Gordon Sharp in the newly established
biophysics laboratory in the School of Medicine
here. Dr. Smith has worked with Dr. Sharp in ex-
periments using the electron microscope.

At Baylor University, Dr. Smith will work with
Dr. Joseph Melnik, and continuation of experi-
ments begun at Chapel Hill will be possible.

:Jc >»-. :;:

Dr. Richard Dobson, head of the Division of Der-
matology, spoke recently before the first Interna-
tional Congress of Histochemistry in Paris, France,
on the subject of "The Histochemistry of the Hu-
man Sweat Gland."

Dr. Dobson is engaged in various studies of the
skin and the sweat glands.

Eleventh Annual Winston-Salem
Heart Symposium

The eleventh annual Winston-Salem Heart Sym-
posium will be held at the Robert E. Lee Hotel in
Winston-Salem on October 7. The program follows.
Morning
9:30-10:25 Presiding: Robert L. McMillan, M.D.
Governor, North Carolina American
College of Physicians, Winston-Salem
"Recent Advances In Experimental
Atherosclerosis"

Thomas H. Clarkson, D. V. M., Win-
ston-Salem
10:25-11:15 "Human Atherosclerosis and Lipid
Metabolism: Current Concepts"
Donald Fredrickson, M.D., Bethesda,
Maryland

September, 1960

BULLETIN BOARD

393

11:30 A.M.-1:00 P.M. Panel

"Clinical Management of Athero-
sclerosis"

Diet, Cholestorol-lowering Drugs,
Anti-coagulant, Surgery
Moderator: Robert W. Priehard, M.D., Winston-
Salem
Participants: Edward S. Orgain, M.D., Durham
Henry T. Bahnson, M.D., Baltimore,
Maryland

Donald Fredrickson, M.D., Bethesda,
Maryland
1:00 P.M. Lunch

Afternoon

2:00- 2:50 Presiding: Charles R. Welfare, M.D.,
Winston-Salem, President, Forsyth
County Medical Society
"Treatment of Hypertensive Vascular
Disease"
Edward S. Orgain, M.D., Durham

2:50- 3:40 "Surgical Management of Vascular
Occlusive Disease" With Special
Comments on Treatment of Carotid
Obstructive Syndromes.
Henry T. Bahnson, M.D.

3:50- 4:40 "External Cardiac Resuscitation"

A New Technique of Cardiac Massage
Without Opening the Chest.
James R. Jude, M.D., Baltimore,
Maryland

4;: 40- 5:40 P.M. Clinico-Pathological Conference
Edward S. Orgain, M.D.

6:00- 7:00 Social Hour

7:00 Dinner

Presiding: Mr. James A. Way,
President, Forsyth County Heart
Association, Winston-Salem
Speaker: Dr. Mark Depp, Pastor,
Centenary Methodist Church,
Winston-Salem

Introductions: Benjamin F. Huntley,
M.D., Chairman, Heart Symposium,
Winston-Salem

Seminar on Athletic Injuries

The University of North Carolina School of
Medicine, in cooperation with the North Carolina
High School Athletic Association and the North
Carolina Committee on Trauma of the American
College of Surgeons, co-sponsored a one-day sem-
inar on "The Prevention and Management of
Athletic Injuries" at North Carolina Memorial
Hospital on September 21.

Guest member of the seminar faculty was Dr.
Charles J. Frankel of the Department of Ortho-
pedic Surgery and athletic team physician of the
University of Viriginia. Dr. William P. Richard-
son, assistant dean for continuation education pre-
sided. - ■■■'_■

North Carolina Heart Association

Dr. Eugene A. Stead, Jr., professor and chair-
man of Medicine at Duke, will deliver the Lewis A.
Conner Memorial Lecture at the opening Scientific
Session of the American Heart Association's an-
nual meeting in St. Louis on October 21. His topic-
is "Physiology of the Circulation as Viewed by the
Internist." The remainder of this session will be
conducted jointly by the American Heart Council
on Clinical Cardiology and the American College
of Cardiology.

Forms for registering for attendance may now
be obtained from the North Carolina Heart Asso-
ciation, Miller Hall, Chapel Hill, North Carolina.

North Carolina Board of
Medical Examiners

The North Carolina State Board of Medical Ex-
aminers will meet at the Virginia Dare Hotel, Eliz-
abeth City, on October 7, to interview applicants
for license by endorsement.

Ninth District Medical Society
Symposium

The annual Ninth District Medical Society Sym-
posium will be held at Moose Lodge in Morganton
on September 29.

Officers of the Ninth District Society are: pres-
ident— Dr. G. M. Billings; vice president, Dr. J. B.
Helms; secretary-treasurer, Dr. L. B. Snow.

For further information, write, Dr. L. B. Snow,
Drawer 150, Morganton, North Carolina.

Edgecombe-Nash Medical Society

The Edgecombe-Nash Medical Society held its
monthly meeting in Rocky Mount on August 10.
Dr. Raymond Adams of the Department of Neur-
ology, Medical College of Virginia, was guest
speaker.

News Notes

Drs. Hall, Lafferty, Coppedge, Burnett, and

Roth of Charlotte have announced the association

of Dr. Hugh Harrison Hayes, Diplomat of the

American Board of Radiology, in the practice of

radiology.

* * *

Drs. Paul W. Sanger and Frederick H. Taylor
of Charlotte announce the association of Dr. Fran-
cis Robicsek in the practice of cardiovascular and
thoracic surgery.

Southeastern Rural Health Conference

Physicians and farm group representatives from
11 Southeastern states will gather in Atlanta,
October 7-8, for the first regional conference on
rural health.

"Joining Hands for Community Health" is the
theme of the meeting, which will be held at the
Dinkier Plaza Hotel and is sponsored by the

394 NORTH CAROLINA MEDICAL JOURNAL September, 1960

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Phones: BRoadway 5-3400 BRoadway 5-5035

September, I960

BULLETIN BOARD

395

American Medical Association's Council on Rural
Health.

High light of the conference will be a banquet
address Friday evening, October 7, by Dr. Julian P.
Price, Florence, South Carolina, newly appointed
chairman of A.M.A.'s Board of Trustees.

Conference co-chairmen are Drs. Francis T. Hol-
land, Tallahassee, Florida, and W. Wyan Wash-
burn, Boiling Springs, North Carolina.

SOUTHEASTERN SURGICAL CONGRESS
The Southeastern Surgical Congress announces
a prize award contest open to residents of ap-
proved hospitals in the Southeastern states for the
best scientific papers submitted

Papers are due at the Congress office at 340
Boulevard, N.E., Atlanta 12, Georgia, before De-
cember 1, 1960.

First prize is an all-expense-paid trip to the
meeting at Miami Beach, Florida, March 6-9, 1961,
in addition to a cash award.

Emory University School of Medicine

The Department of Ophthalmology, Emory Uni-
versity School of Medicine, will sponsor a post-
graduate course in ophthalmic surgery to be held
on December 1 and 2, 1960, in the auditorium of
the Grady Memorial Hospital, Atlanta, Georgia.

Diagnostic principles and techniques, preopera-
tive and postoperative management, and surgical
principles and techniques in extraocular muscle
surgery, cataract surgery and glaucoma surgery
will be discussed.

American College of Gastroenterology

The twenty-fifth annual convention of the
American College of Gastroenterology will be held
at the Bellevue-Stratford Hotel in Philadelphia,
Pennsylvania on October 24, 25, and 26.

For copies of the program and additional infor-
mation, please write to the American College of
Gastroenterology, 33 West 60th Street, New York
23, New York.

American Board of
Obstetrics and Gynecology

The next scheduled examination (Part 1), writ-
ten, will be held in various cities of the United
States, Canada, and military centers outside the
Continental United States, on Friday, January 13,
1961.

Reopened candidates are required to submit case
reports for review 30 days after notification of
eligibility. Scheduled Part 1 and candidates resub-
mitting case reports are required to submit case
reports prior to August 1 each year.

Current Bulletins may be obtained by writing
to Dr. Robert L. Faulkner, executive secretary and
treasurer, 2105 Adelbert Road, Cleveland 6, Ohio.

American College of Chest Physicians

The Southern Chapter of the American College
of Chest Physicians will hold its seventeenth an-
nual meeting at the Statler-Hilton Hotel, St. Louis,
Missouri, Ocober 30-31, 1960. All physicians are
cordially invited to attend. There is no registration
fee.

National Conference on the
Medical Aspects of Sports

The Second National Conference on the Medical
Aspects of Sports sponsored by the American Med-
ical Association will be held in Washington, D. C,
at the Statler Hotel on November 27. The confer-
ence will immediately precede the annual Clinical
Meeting of the American Medical Association, No-
vember 28-December 1, 1960.

As was true of the first meeting on this subject,
held last year in Dallas,, the Second Conference
will cover a wide range of subjects. Included will
be papers, panels, and discussions relating to
training and conditioning, prevention of injuries,
recognition, referral and treatment of injuries, the
psychology of sports participation and other sub-
jects.

Those interested in receiving announcements
concerning the conference should address The
Secretary, Committee on the Medical Aspects of
Sports, American Medical Association, 535 North
Dearborn, Chicago 10, Illinois.

Guild of Prescription Opticians
of America, Inc.

Dr. William R. Harris of Henderson, North Car-
olina is among six new residents in ophthalmology
who have been announced as the 1960 winners of
fellowships provided by the Ophthalmology Schol-
arship Fund of the Guild of Prescription Opticians
of America, Inc. Dr. Harris will serve his resi-
dency at the Ohio State University Hospital, Co^
lumbus, Ohio.

American Medical Writers Association

Because of a conflict with observance of Yom
Kippur on October 1, the American Medical
Writers' Association has changed the dates of its
seventeenth annual meeting to November 18 and
19, 1960, Dr. Austin Smith, president of the so-
ciety, has announced. The meeting will be held at
the Morrison Hotel in Chicago.

The National Foundation

Postdoctoral fellowships are offered by the Na-
tional Foundation to candidates for training in re-
search, orthopedics, preventive medicine, arthritis
and related diseases, and rehabilitation. The clos-
ing date for submitting applications to be reviewed
in February is November 1.

:;;»;

NORTH CAROLINA MEDICAL JOURNAL

September, 19(50

Catholic Hospital Association

The new Catholic Hospital Association publica-
tion on the care of the aged, "The Administration
of Long-Term Care Facilities," is now available.

Sixteen recognized authorities in the field of
geriatric care present material relating to the
various aspects of care for the aged in an institu-
tional setting. The papers also deal with problems
of administration in such facilities.

Price of the new publication is $1.50 each. Quan-
tity prices are available on request from the Pub-
lications Department, Catholic Hospital Associa-
tion, 1438 South Grand Boulevard, St. Louis 4,
Missouri.

Society of Nuclear Medicine

The Society of Nuclear Medicine recently con-
cluded its seventh annual meeting in Estes Park,
Colorado. The following officers were elected:

President: Titus C. Evans, Ph.D., Iowa City, Iowa
President-elect: Lindon Seed, M.D., Chicago,

Illinois
Vice President: Paul Meadows, M.D., Pittsburgh,

Pennsylvania
Vice President-Elect: J. R Maxfield, Jr., M.D.,

Dallas, Texas
Secretary: Robert W. Lackey, M.D., Denver,

Colorado
Treasurer: William H. Beierwaltes, M.D., Ann

Arbor, Michigan

The eighth Annual Meeting of the Society of
Nuclear Medicine will be held at the Penn Shera-
ton Hotel. Pittsburgh, Pennsylvania, June 14-17,
liliil

For further information, address all inquiries to
the Administrator, Society of Nuclear Medicine,
430 N Michigan Avenue, Chicago 11, Illinois.

Animal Care Panel

Unusual new techniques for handling animals
used in scientific research will high-light the
eleventh annual meeting of the Animal Care Panel
to be held in St. Louis, October 26-28. The success
with hypnotism of small animal subjects will be
one of the newer innovations to be reviewed.

Currently there are slightly more than 800 mem-
bers in the Animal Care Panel. They include med-
ical scientists, veterinarians, and caretakers,
breeders and dealers of animals.

United States Civil Service Commission

At least 1,450,000 employees have enrolled in the
federal employees health benefits program accord-
ing to preliminary and incomplete registration
figures received from 35 of the 38 carriers of par-
ticipating health benefit plans, the Civil Service
Commission announced recently. The new program
went into effect early in July.

adult
stable
diabetics

sulfonylurea
failures

respond to

trademark,
brand of Phenformin HCI

adult stable diabetes

"In our experience the action of DBI on the adult stable
type of diabetes is impressive . . . 88% were well controlled
by DBI."i

"Most mild diabetic patients were well controlled on a
biguanide compound [DBI], and such control was occa-
sionally superior to that of insulin. This was true regardless
of age, duration of diabetes, or response to tolbutamide."2

"DBI has been able to replace insulin or other hypogly-
cemic agents with desirable regulation of the diabetes when
it is used in conjunction with diet in the management of
adult and otherwise stable diabetes."3

sulfonylurea failures

Among those diabetics who responded to tolbutamide ini-
tially and became secondary failures DBI "gave a satis-
factory response in 55%. "4

"DBI is capable of restoring control in a considerable por-
tion of patients in whom sulfonylurea compounds have
failed, either primarily or secondarily."5

"All twelve secondary tolbutamide failures have done well
on DBI. "6

"34 out of 59 sulfonylurea primary failures were success-
fully treated with DBI."7

September, 1960

BULLETIN BOARD

397

U. S. Department of
Health, Education, and Welfare

The cooperation of physicians is requested in
studies on colon and rectal carcinoma recently in-
itiated at the Clinical Center, National Institutes
of Health, Bethesda, Maryland. Encouraging re-
sults in the treatment of gastrointestinal carcin-
oma have been reported using the pyrimidine an-
alogues 5-fluorouracil and 5-fluorodeoxyuridine.
However, other reports have raised the question
of their effectiveness.

The Chemotherapy Service of the National Can-
cer Institute is conducting studies of these agents
in carcinoma of the colon and rectum in order to
better define their place in the treatment of meta-
static gastrointestinal neoplasm.

Patients can be accepted for these studies if they
are ambulatory, have normal leukocyte count,
renal and hepatic function and if they have meta-
stases in the lung, peripheral lymph nodes (such
as supraclavicular or cervical) or skin.

Referrals of such patients will be greatly ap-
preciated. Physicians who wish to have their pa-
tients considered for study at the National Cancer
Institute may write or call: Dr. Clyde 0. Brindley,
or Dr. Paul P. Carbone, National Cancer Institute,
Bethesda 14, Maryland.

A National Center for Health Statistics has

been established in the Public Health Service, the
Surgeon General, Dr. Leroy E. Burney, has an-
nounced.

The new organizational unit brings together the
major PHS activities concerned with measurement
of the health status of the nation and identification
of significant associations between characteristics
of the population and health-related problems.

Initially it will have two divisions: the U. S.
National Health Survey, which was transferred to
it on August 15; and the National Office of Vital
Statistics, which will become part of it on October
1. It will supplement but not supplant the statis-
tical work associated with particular Public Health
Service programs, and which will continue as in-
tegral parts of those programs.
* * *

Sister Hilary Ross, a biochemist, internationally
known for her laboratory research on leprosy, was
honored last month by Surgeon General Leroy E.
Burney of the Public Health Service on the occa-
sion of her retirement after 37 years of duty at the
national leprosarium, officially the U. S. Public
Health Service Hospital, Carville, Louisiana.

Dr. Burney will present to Sister Hilary a cer-
tificate citing her for outstanding contribution to
the care and welfare of patients with leprosy and
for dedicated effort in developing and communicat-
ing- new knowledge on this disease.

blood sugar
in mild,
moderate
and severe
diabetes,

in
children
and
adults

not a sulfonylurea... DBI

(N^P-phenethylbiguanide) is
available as white, scored tablets of
25 mg. each, bottles of 100.

Send for brochure with complete dosage
instructions for each class of diabetes,
and other pertinent information.

1. Walker, R. S.: Brit. M. J. 2:405, 1959.

2. Odell, W. D., etal.: A.M.A. Arch. Int. Med.
102:520, 1958.

3. Pearlman, W.: Phenformin Symposium,
Houston, Feb. 1959.

4. DeLawter, D. E., et al.: J.A.M.A. 171:1786
(Nov. 28) 1959.

5. McKendry, J. B., et al.: Canad. M. A. J.
80:773. 1959.

6. Miller, E. C: Phenformin Symposium,
Houston. Feb. 1959.

7. Krall, L. P.: Applied Therapeutics 2:137, 1960.

an original development from the research
laboratories of

u. s. vitamin & pharmaceutical corp.

Arlington-Funk Laboratories, division
250 East 43rd Street, New York 17. N. Y.

::;i8

NORTH CAROLINA MEDICAL JOURNAL

September, I960

Veterans Administration

A search for some of the basic defects that oc-
cur in the brain in Parkinson's disease, a condition
afflicting an estimated 500,000 older persons in the
United States, is under way at the Durham, North
Carolina, Veterans Administration hospital.

A medical team under leadership of Dr. Blaine
S. Nashold, Jr., a neurosurgeon, is investigating
the effects of drugs in a selected group of patients,
in the hope that findings will lead to development
of new and improved treatment methods for the
disease.

Appointment of Dr. Robert C. Parkin of Madi-
son, Wisconsin, as chief of professional training
services in medical education for the Veterans Ad-
ministration, in Washington, D. C, was announced
by the agency recently.

In his new post, Dr. Parkin will help coordinate
VA medical education programs which assist in
training one out of each three new physicians and
one out of each 10 professional nurses being pro-
duced by the nation.

Entitled "The Cancer Detection Examination,"
the forty-six-minute, sound film demonstrates pre-
symptomatic detection of cancer through a simple
thirty to forty-minute procedure in the doctor's
office.

The material is being offered by Lilly as a free
service to physicians.

Lilly salesmen may be contacted by groups of
physicians for complete information.

New Film Shows Detection Techniques for Cancer
A 16-mm., black-and-white movie showing de-
tection techniques for cancer, which kills more than
250,000 persons in the United States every year, is
being offered by Eli Lilly and Company for view-
ing by qualified professional groups.

The president of a small drug making company
declared recently that "the balance on the pharm-
aceutical industry's ledgers looms more largely
in the public eye than the physiologic wonders our
products work and for which mankind has waited
since time began."

Speaking to the annual meeting of the Pharm-
aceutical Manufacturers Association, William C.
Conner of Alcon Laboratories, Ft. Worth, Texas,
told the prescription drug makers they "no longer
toil in blissful anonymity."

He said, "whatever further action — on the legis-
lative scene or elsewhere — comes out of the in-
vestigation, the smaller segments of this com-
petitive, free-enterprise industry stand to suffer
at least as much as the larger segments."

Conner pointed out that nearly a third of the
companies in the PMA membership do an annual
business of less than $1 million.

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Concerning Your Health and Your Income

A special report to members of the Medical Society of

the State of North Carolina

on the progress of the Society's

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in effect since 1940

PROUDLY WE REPORT 1959

AS OUR MOST SUCCESSFUL YEAR IN SERVING YOUR SOCIETY.

During the year we introduced a NEW and challenging form of disability protec-
tion. There has been overwhelming response on the part of the membership.

Participation in this Group Plan continues to grow at a fantastic rate.

1960

is our 20th year of service to the Society. It is our aim to continue to lead the field in pro-
viding Society members with disability protection and claim services as modern as tomor-
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September, 1960

BOOK REVIEWS

399

New Anti-inflammatory Agent Introduced

An oral systemic anti-inflammatory enzyme
tablet formulated especially for intestinal ab-
sorption has been introduced by Armour Pharma-
ceutical Company.

Named Chymoral, the product is indicated in all
conditions where inflammation and swelling are
present. Chymoral speeds reduction of hematoma
and edema in injuries, reduces pain and speeds
wound healing. It may be used in conjunction with
other medications.

Clinical investigators reported "good" to "ex-
cellent" results in 389 cases out of 478, or 82.5
per cent, when Chymoral was used. Cases included
asthma, bronchitis, sinusitis, fractures, contusions,
bruises, thrombophlebitis, pelvic inflammation, a
number of skin conditions, and such miscellaneous
conditions as hemorrhoids, cellulitis and conjunc-
tivitis.

Chymoral is an enteric coated tablet containing
both trypsin and chymotrypsin. The product is the
newest form of chymotrypsin which is already
available in parenteral and buccal form and as an
ointment.

A prescription product, Chymoral is supplied in
bottles of 48 tablets. The initial dosage is two
tablets four times a day, and one tablet four times
a day for maintenance. The tablets may be used
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BOOK REVIEWS

Manual for Examination of Patients. By

Kenneth L. White, M.D., and others. 231
pages. Price, $4.50. Chicago: The Year
Book Publishers, 1960.
This manual, put together at the University of
North Carolina School of Medicine for the benefit
of students, proved so satisfactory that it has now
been offered as a handy, paper-backed reference for
students elsewhere. As such, it fills a need which
has existed for some years. Books on physical diag-
nosis in general are vei'bose, redundant, and poor-
ly correlated with pathology, physiology, and lab-
oratory diagnosis. Insufficient attention is usually
given to the finer points of history-taking, which
have been developed so well by psychiatrists. It is
therefore a delight to see Dr. White and his col-
leagues offer a volume with so rational an ap-
proach. The only comparable volume, "Essentials
of Diagnostic Examination" by Dr. John B. You-
mans, was published in 1940 and has been long out
of print.

Some of the manual could have been
re-written, particularly certain sections on labora-
tory procedure. Not all hospitals and medical
schools follow the same laboratory procedures as
does the University of North Carolina Medical
Center. For example, measurement of butanol ex-
tractable iodine (BEI) and quantitative urine cul-
ture are unfortunately not available at all med-
ical schools. Perhaps the publishers rather than
the committee are responsible for this defect, be-
cause a little critical reading could have made it
apparent. It is a small criticism, however, in light
of the generally comprehensive approach offered.
The book is heartily recommended for medical
students, particularly for those taking physical
diagnosis, and for junior students first seeing pa-
tients on the ward.

Medicine Today. By Marguerite Clark. 360
pages. Price, $4.95. New York: Funk &
Wagnalls Company, 1960.
This book is an excellent summary of the pro-
gress made by medicine during the past decade. It
is well written, and for the most part gives a re-
liable account of recent medical discoveries. Can-
cer, mental disease, arthritis and rheumatism,
virus diseases, pediatrics, "women and their ills,"
and reducing diets are discussed. A chapter is de-
voted to the achievements of the pharmaceutical
industry. The final chapter, which should keep the
medical reader humble, is on "Diseases Uncon-
quered."

Its easy, chatty style makes the book easy to
read, and it should not frighten the non-medical
reader, unless he — or she — is the kind that takes
all medical descriptions too seriously. The best
chapters are on psychosomatic disorders and on
reducing diets.

11)1)

NORTH CAROLINA MEDICAL JOURNAL

September, 1960

A few minor criticisms will occur to the medical
reader. The discussion of gout is rather sketchy,
and the old standby, colchicine is not even men-
tioned. The undesirable side effects of the steroids
might have been stressed more. Designating vac-
cine as ".erom" is a common practice of laymen
which is particularly irritating to medical men.

It is unfortunately true, as Mrs. Clark points
out, that many unnecessary operations are per-
formed. Her chc!c3 of a case report, however, was
not convincing evidence. A 25 year old woman
operated on for acute appendicitis was found to
have a normal appendix, but a ruptured tubal
pregnancy. Since the differential diagnosis be-
tween the two conditions may be quite difficult,
and since a ruptured tubal pregnancy is certainly
as grave an emergency as acute appendicitis, no
surgeon should need to apologize for having oper-
ated.

In spite of these minor criticisms, a doctor can
recommend the book to patients who want to keep
up to date on medical progress, and most doctors
can themselves learn much from it.

Moses Ben Maimon (Maimonides). The
Preservation of Youth, translated by
Hirsch L. Gordon, M.D., Ph.D., D.H.L., 92
pages. Price, $2.75, Philosophical Library,
New York, 1960.

Moses ibn Maimon was a great physician of the
12th century. A Jew of Cordova, and better known
as Maimonides, he wrote voluminously. He served
as the personal physician to Saladin of the Cru-
sades fame and also to Saladin's son, Sultan Al
Afzal. Upon the request of the latter he wrote a
collection of essays concerning health, Fi Tadbir
as-Sihha, and dedicated to Al Afzal.

Dr. Gordon ably translated and edited these es-
says under the title, "The Preservation of Youth."
Very few works of Eastern medical writers of the
golden age of Islam are translated fully into Eng-
lish, and this book is a welcome entry.

Maimondes, though born in Spain, was certainly
one of the great physicians of the Arab world. He
also was a noted Jewish theologian. "From Moses
to Moses there was no greater," says a Jewish
proverb, meaning from Moses the Prophet to
Moses the Maimonides. Nevertheless, the pub-
lishers of this book claim that this is "one of the

unique medical works of Western culture"

"translated from the original Arabic"! To this re-
viewer's knowledge very few, if any, great works
of Western culture were written by Eastern
authors, and in Arabic.

Maimonides borrowed heavily from great phy-
sicians of Islam. This in itself is advantageous to
the reader of this book since he can get some in-
sight into the general trend of medical science of
the Moslems as it was at the end of the most ad-
vanced period. The translator has well captured the
literary style of Maimonides and brought into lime-

light important points. Throughout the book are
such remarks as: "Nothing is absolute in medi-
cine: ... Be optimistic, everything is a matter of
probability . . . Urban air is polluted, so live in
the country or suburbs . . . Science is complicated,
the more we leam the less we know . . . Take a
short bath every day . . Use music as a therapeutic
adjunct . . ." These remarks seem to be coming
out of today's textbooks; however, they were
written over eight centuries ago!

It is encouraging to students of the history of
medicine, and particularly to students of Islamic
medicine, to see the translation of a complete
work in this field. Dr. Gordon's translation of
Maimonides certainly deserves to be in any phy-
sician's library.

Foundation Makes New Health Film
A 22 minute film on preventive medicine has
been announced by the Smart Family Foundation,
for showings to PTA groups, pediatricians, public-
health meetings, and in schools.

Entitled "Journey in Health," this 16 mm. sound
motion picture stresses the importance of having
the family doctor regularly and continually super-
vice a child's health.

Since "Journey in Health" was prepared as a
public service by the Smart Family Foundation, it
is available at below-cost price. Prints may be ob-
tained in color for $50; in black-and-white for $10,
from the Smart Family Foundation, 65 E. So.
Water St., Chicago 1.

X-RAY Equipment for sale or exchange. 100 K.V.
100 M.A. Picker Radiographic unit with manual
operated tilt table combined with Fluoroscope
unit beneath the table. Provides instant change
over from Fluoroscopy to Radiography with spot
film device. Has had some use but is in excellent
working order also dark room equipment, mag-
netic type plate changer. Stereoscopic view boxes,
etc., will consider late model Ultra-violet lamp,
surgical endotherm in exchange. Write Box 790,
Raleigh, North Carolina.

AVAILABLE Desirable twelve hundred and fifty
square feet space suitable for doctors or dentist.
Ground floor Cameron Court apartments, corner
Snow and Morgan Streets, Raleigh. Air con-
ditioned, also heat, lights, water and parking.
On long lease will improve to suit tenant. Apply
A. W. Criddle, Manager, Temple 2-5395.

WANTED Otolaryngologist and or Ophthalmolo-
gist for extremely successful Asheville and
Western Carolina practice. Dr. Joseph McGowan
recently deceased. Fully equipped office, exper-
ienced personnel. Contact Mrs. Joseph McGowan,
303 Vanderbilt Road, Asheville, North Carolina.

PRACTICE opportunity. For sale. Complete equip-
ment of successful physician for practice Internal
Medicine and offices. Professional Bldg. Raleigh
available. Write box 1951, Raleigh.

September, 1960

IN MEMORIAM

401

Kit JtUmorram!

Earl W. Brian, M.D.
April 9, 1907— August 1, 1960

Dr. Eai-1 W. Brian, Raleigh physician and a
member of the State Board of Health, died at Duke
Hospital, Monday, August 1, 1960, at 2:00 a.m.
after an illness of several weeks.

He had been admitted to the hospital on July 13,
1960, and had been critically ill since that time.
Funeral services were held at the Edenton Street
Methodist Church in Raleigh, conducted by Dr.
Howard P. Powell, his pastor, and the Rev. R. H.
Baum, pastor of Ebenezer Methodist Church.

A native of Arkansas, Dr. Brian received his
medical degree at Duke University in 1934. He had
practiced medicine in Raleigh since 1939 and was
active in professional and civic life and in the
Edenton Street Methodist Church of which he was
a member. He was a certified member of the
American Board of Internal Medicine and had been
a member of the Wake County and the Medical
Society of the State of North Carolina since 1939.

In 1958, Dr. Brian was elected to membership
on the State Board of Health by the Medical So-
ciety of North Carolina, and served on this Board
until his death.

Dr. Brian was president of the Wake County
Medical Society for the year 1956-57, president of
the Raleigh Kiwanis Club in 1953, and president
of the Executives Club in 1958. He was selected as
Raleigh's "Kiwanian of the Year" in 1957 and
was vice president of the United Fund of Raleigh
in 1956-1957. At the time of his death, he was a
member of the Board of Directors of the Salvation
Army and of the Occoneechee Boy Scout Council.

Dr. Brian was instrumental in the organization
of the Wake County Cancer Society, was active in
the Heart Association, and for 17 years was a
member of the board of the Wake County Tuber-
culosis Association.

He is survived by his wife, the former Blanche
Barringer; two daughters, Mrs. Roy Sehmichel of
Southburg, Connecticut, and Betsy Brian of the
home; a son, Earl Brian, Jr., a pre-medical stu-
dent, who is spending the summer in Germany;
and four brothers and four sisters.

James Graham Ramsay, M.D.

On May 7, 1960, the Supreme Architect of the
Universe summoned Dr. James Graham Ramsay to
his celestial home above, there to receive the re-
ward of a well spent life.

Dr. Ramsay was a member of the medical and
surgical staff of Tayloe Hospital prior to its clos-
ing and the opening of Beaufort County Hospital
in May, 1958, when he joined the staff of the latter,
remaining a member until the time of his death.
He endeared himself to his associates and all with
whom he came in contact.

A dedicated and devoted physician and surgeon
has gone, for the moment, from our midst, but we
honor his memory today as one who gave his life
in service to the profession, and left for us high
and lofty ideals, attained only by those who are
so dedicated and because of whom the world is
blessed.

In his death we are deprived of his genial pre-
sence and wise counsel, and this community has
lost an able physician and surgeon, as well as a
good citizen and friend.

Now therefore be it resolved that to his family
and loved ones we express our deep and abiding
sympathy in their great loss.

John C. Tayloe
E. W. Larkin
James B. Larkin
Beaufort County Hospital

The Month in Washington

Democrats and Republicans are cam-
paigning on opposing planks on the issue of
health care for the aged. The Democratic
party advocates the Social Security ap-
proach; the Republican party favors fed-
eral aid in the field, but outside the Social
Security system.

The GOP plank pledged :

"Development of a health program that
will provide the aged needing it, on a sound
fiscal basis and through a contributory sys-
tem, protection against burdensome costs
of health care. Such a program should :

" — Provide the beneficiaries with the
option of purchasing private health insur-
ance— a vital distinction between our ap-
proach and Democratic proposals in that it
would encourage commercial carriers and
voluntary insurance organizations to con-
tinue their efforts to develop sound cover-
age plans for the senior population.

" — Protect the personal relationship of
patient and physician.

" — Include state participation."

The key paragraph of the Democratic
plank stated :

"The most practicable way to provide
health protection for older people is to use
the contributory machinery of the Social
Security system for insurance covering hos-
pital bills and other high cost medical
services. For those relatively few of our
older people who have never been eligible
for Social Security coverage, we shall pro-

From the Washington Office of the American Medical As-
sociation.

402

NORTH CAROLINA MEDICAL JOURNAL

September, 1000

vide corresponding benefits by appropria-
tions from the general revenue."

Charles H. Percy, chairman of the GOP
Platform Committee, stated that the refer-
ence to a "contributory system" in the Re-
publican plank did not mean a Social Se-
curity tax.

Presidential and Vice Presidential candi-
dates of both parties went into the election
campaigns pledged to support the health-
care-for-the-aged planks adopted by their
respective conventions. Vice President Rich-
ard M. Nixon, the GOP Presidential nom-
inee, already was on record as unalterably
opposed to any program of national com-
pulsory health insurance. The long-estab-
lished position of Senator John F. Kennedy
of Massachusetts, the Democratic Presiden-
tial candidate, has been "that only by use
of the Social Security system can we have
true health insurance."

Speaking for the American Medical As-
sociation, Dr. Edward R. Annis of Miami,
Florida, appeared before the platform-
drafting committee of the Democratic con-
vention at Los Angeles, and Dr. Leonard
W. Larson, A.M. A. President-elect, before
the Republican policy group at Chicago.

The A.M.A. spokesmen warned both par-
ties that a program following the Social Se-
curity approach "would be unpredictably
costly; it would unnecessarily cover mil-
lions of people ; it would substitute service
benefits for cash benefits; it would lead to
poorer — not better — quality of medical
care ; it would overcrowd our hospitals ; it
would lead to the decline, if not the demise,
of private health insurance ; and it would
interfere dangerously with the doctor-pa-
tient relationship, which is the solid foun-
dation upon which effective medicine must
be based."

Dr. Annis also urged support of the
House-approved Mills plan to provide
health care for the needy aged who need
help, with the federal government and the
states sharing the costs outside the Social
Security mechanism.

In an advertisement run in some large
daily newspapers in mid-August, the A.M.A.
outlined its reasons for supporting the
Mills plan. The ad said, in part :

"The A.M.A. believes our nation, as well
as its senior citizens, will best be served by
a locallv administered health aid program
designed TO HELP THOSE WHO NEED
HELP . . .

". . . We are equally sincere in our op-
position to legislative measures that ap-
proach the problem on a shotgun basis —
with the idea of increasing repeatedly the
Social Security tax in order to finance
health benefits for EVERYONE who is
covered by the Old Age, Survivors and Dis-
ability Insurance program, regardless of
their need.

"There are many serious hazards in us-
ing the Social Security approach to finance
medical and hospital care for our older
citizens. When government starts telling
the doctor how to practice medicine ; telling
the nurses how to nurse; telling the hos-
pital how to handle its patients, the qual-
ity of medical care is sure to decline. The
cost of such a program eventually would be
staggering, and would make a serious dent
in the pay envelopes of millions of Ameri-
cans covered by Social Security.

"Most important, perhaps, is the fact
that such an approach would just be the be-
ginning of compulsory, government-run
medical care for every man, woman and
child in the United States. For it wouldn't
be long before the Federal Government
would be lowering the age at which people
would be eligible, and adding one costly
services after another to a program that
would place your health care under the Fed-
eral Government's thumb. And let's not
forget that our present health care is recog-
nized to be the world's finest."

Attention Medical Doctors

Our town of 600 pop. and county of 10,000 pop.
without a doctor. A ready-made practice will
net $25,000 yearly or more. Our needs are great
and immediate. Can offer equipped office and /or
residence for rent.

If interested, call collect or contact:

Hugh Harris, Ned Delamar, or Hubert Smith
Oriental, North Carolina

(Where hunting, fishing, & boating abound the
year around)

1960

TRANSACTIONS

OF THE

AUXILIARY TO THE MEDICAL SOCIETY

OF THE STATE OF NORTH CAROLINA

THIRTY-SEVENTH ANNUAL MEETING

held at

RALEIGH, NORTH CAROLINA
MAY 8-11, 1960

President, Mrs. R. L. Garrard, Greensboro

Recording Secretary, Mrs. H. D. Riddle, Gastonia

Treasurer, Mrs. Ralph Deaton, Jr., Greensboro

—INDEX—

Auditor's Report 410 General Meeting 408

Board of Directors' Annual Meeting 404 House of Delegates Annual Meeting 406

Election of Officers 409 Treasurer's Report 409

404

NORTH CAROLINA MEDICAL JOURNAL

September, 1960

Transactions
1960-1961

AUXILIARY TO THE MEDICAL SOCIETY

of the

STATE OF NORTH CAROLINA

Memorial Service, Sunday, May 8, 1960

The Memorial Service of the Auxiliary to the
Medical Society of the State of North ' Carolina
was held Sunday, May 8, 1960, together with the
Medical Society, in the Elizabeth Room, Sir Walter
Hotel, Raleigh. Invocation was given by Dr.
Charles H. Pugh, Chairman of the Committee on
Necrology, and was followed by the Roll Call of
the seventy-nine deceased physician-members of
the Society.

With words of tribute, Mrs. William P. Richard-
son, Chairman of the Memorials Committee of the
Auxiliary to the Medical Society, read the list of
eight deceased Auxiliary members.

A choral presentation was given by the Rex
Hospital Nurses' Choir, under the direction of Dr.
Frederick S. Smith, Director of Public School
Music, Raleigh City Schools. The program in-
cluded "Lord's Prayer", "Holy City", "List to the
Lark", and "God is Good to All Creation".

Rev. James G. Huggin, pastor of the First
Methodist Church, Gastonia, N. C, delivered the
Memorial address, which was followed by a
Choral Postlude and the Benediction.

Deceased Auxiliary Members — 1959-60

Mrs. George W. Brown, Raeford

Mrs. A. C. Bulla, Raleigh

Mrs. J. B. Chandler, Fayetteville

Mrs L. O. Dunlap, Albemarle

Mrs. William M. Jones, Gastonia

Mrs. W. A. Sams, Marshall

Mrs. Will C. Sealy, Durham

Mrs. J. N. Taylor, Greensboro

Mrs. H. D. Riddle
Recording Secretary

Mrs. R. L. Garrard

President

Date: June 3, 1960

Finance Committee Meeting — May 9, I960
Present: President, President-Elect, ' First Vice-
President, Treasurer, Recording Secretary

The Finance Committee met for coffee and rolls
in the President's Suite at 9:15 A.M., May 9, 1960,
with Mrs. W. Ralph Deaton, Jr., presiding. Mrs.
Deaton presented the Financial Statement, which
was accepted, with the addition of notes made on
attached mimeographed copy. The Tentative Bud-
get for 1960-61 was accepted with three changes —
Publicity was reduced to $5.00, By-Laws increased
to $10.00, and Health Careers increased to $60.00
(noted on attached copy). These changes did not
affect the balance of the totals.

There was discussion on expenses incurred by
the President in connection with the Yearbook, and
it was decided that she should be reimbursed.

There being no further business, the meeting was
adjourned.

Mrs. H. D. Riddle
Recording Secretary

Mrs. R. L. Garrard

President

Date: June 3, I960

Executive Committee Meeting — May 9, I960
Present: President, President-Elect, Treasurer, 1st

Vice-President, Parliamentarian, 2nd Vice-Presi-
dent, Recording Secretary.

The Executive Committee met in the President's
suite, Sir Walter Hotel, at 10:00 A.M., with Mrs.
R. L. Garrard presiding.

Mrs. Paul W. Johnson, First Vice-President,
asked to bring a recommendation to the Board of
Directors for approval:

"As 1st Vice-President in charge of Membership
and Organization, I would like to emphasize the
importance of this assignment. Increasing mem-
bership is vital to the strength of the Auxiliary,
and learning more about the membership and
various problems is a challenge. Much thougnt and
imagination are required in fulfilling the functions
of the 1st Vice-President. It ha-; become increas-
ingly evident that our officer alignment or "Chain
of Command" should be made to conform with our
National Auxiliary, namely die 1st Vice-President
is an elected officer, frequently succeeding a^
President-Elect and President. Thus the duties of
1st Vice-President could be a forerunner to the
office of President. In our State Aux. this office is
automatically filled by the out-going President. It
is obvious that a thorough knowledge of Member-
ship and Organization would render a President
much more effective in her service to the Auxil-
iary, and she would find this experience more
helpful before her term as president than after it.
THEREFORE, as immediate Past-President, I
recommend that the 1st Vice-President in charge
of Membership and Organization become a duly
nominated and elected officer each year. This will
necessitate a change in the By-Laws, Article 5,
Section 2."

(Further) If the 1st Vice-President is to become
an Elected Officer, then we should consider that
the out-going President become a Director, serv-
ing for one year, and she will have full responsi-
bility for preparing Report Forms for the use of
Committee Chairmen. These forms are to be pre-
pared and presented the State President for inclu-
sion in the Packets at the Fall Board Meeting.
This would eliminate confusion .incomplete or in-
adequate report forms, and will make our Nation-
al reporting much easier.

After discussion and ruling by the Parliamen-
tarian, it was decided that this could only be pre-
sented in the form of a suggestion, to allow the
lapse of sufficient time before being voted upon.

There being no further business, the meeting
was adjourned.

Mrs. H. D. Riddle
Recording Secretary

Mrs. R. L. Garrard

President

Date: June 3, 1960

Board of Directors' Annual Meeting — May 9, 1960

The 37th Annual Meeting of the Board of Di-
rectors of the Auxiliary to the Medical Society of
the State of North Carolina was called to order by
president, Mrs. R. L. Garrard, at 11: A.M., in the
Hayes-Barton Room, Sir Walter Hotel, Raleigh.
Following the invocation by Mrs. Tolbert Wilkin-
son, a motion was made, seconded and passed to
dispense with the roll call and reading of the
minutes.

Mrs. Garrard introduced Mrs. John M. Chenault,
president of the Auxiliary to the Southern Med-
ical Association, and Mrs. Frank Gastineau, pres-
ident of the Auxiliary to the American Medical
Association.

After a few announcements and expressions of
appreciation, Mrs. Garrard reported that Dr. Ros-

September, 1960

AUXILIARY TRANSACTIONS

405

coe McMillan, Chairman of the Advisory Commit-
tee of the State Medical Society, would not be
with us at that time, due to a conflicting meeting,
but would be present later. Dr. John C. Reece.
President of the Medical Society, was also unable
to be present, but sent greetings in the form of a
letter, which was read by the Recording Secretary,
(attached)

Supplemental Reports, bringing the work of the
Auxiliary up to May 1, were distributed.

Mrs. Paul P. McCain, Chairman of Past Presi-
dents, introduced the past presidents, of whom 14
were present as follows:

Mrs. Benjamin J. Lawrence, Raleigh
Mrs. A. Byron Holmes, Fairmont
Mrs. William P. Knight, Greensboro
Mrs. Charles P. Eldridge, Raleigh
Mrs. Sidney Smith, Raleigh
Mrs. Karl B. Pace, Greenville
Mrs. W. Reece Berryhill, Chapel Hill
Mrs. Watson B. Roberts, Durham
Mrs. Roscoe D. McMillan, Red Spring
Mrs. Powell G. Fox, Raleigh
Mrs. R. B. Croom, Jr., Maxton
Mrs. Donnie M. Royal, Salemburg
Mrs. Paul W. Johnson, Winston-Salem
Mrs. Gilbert M. Billings, Moiganton
Mrs. McCain also reported that she and the
other past presidents usually have lunch together,
and that they have among themselves a floating
fund which is sent to various places, wherever
needed. Last year it was $150.00, and at present
is at the UNC Medical School.

1ST VICE-PRESIDENT— Mrs. Paul W. Johnson
introduced the District Councilors, of whom four
were present, one being a substitute. She then
asked everyone to look at page 17 of the Annual
Repor-ts, and give close attention to her suggestion
there. The Recording- Secretary was asked to read
the following- addendum in connection with this:

"If the 1st Vice-President is to become an
Elected Officer, then we should consider that the
out-going President become a Director, serving for
one year, and she will have full responsibility for
preparing Report Forms for the use of Committee
Chairmen. These forms are to be prepared and
presented to the State President for inclusion in
the Packets at the Fall Board Meeting. This would
eliminate confusion, incomplete or inadequate re-
port forms, and will make our National reporting
much easier."

The President asked that we give this careful
consideration, saying that it will come up as a
recommendation next fall at the Board Meeting.

At this time, Mrs. McCain suggested that the
wife of the President of the Medical Society should
be made an honorary member of the Board of
Directors, so that at future meetings when the
President cannot attend personally, his wife can
bring his greetings. She pointed out that such a
move would make for a more personal relationship
between the Medical Society President and our
Board of Directors. This suggestion will also come
up as a motion at the Fall Board Meeting.

2ND VICE-PRESIDENT— Mrs. Charles D. Thom-
as, introduced the Chairmen of the Sanatoria Bed
Funds, and called attention to the fact that these
funds had been started at the suggestion of Mrs.
McCain.

TREASURER— Mrs. W. Ralph Deaton, Jr.,
passed out copies of the Financial Statement, and
the Tentative Budget for 1960-61. She called at-
tention to the amount for the Yoder Bed, which
might seem unduly high compared to the others,
and explained that the Cooper Bed patient had
been transferred to the Yoder Bed for surgery,

and that the Cooper Bed would remain empty till
this patient returned to it. The Treasurer's report
and tentative budget were accepted and placed on
file.

Other officers present were recognized.
Committee Chairmen

AMEF Chairman, Mrs. Bruce B. Blackmon, made
a correction in the Supplemental Report, stating
that contributions totalled $1944.25 instead of
$2108.25.

"Auxiliary News" Chairman, Mrs. Walter G.
King, was absent, but the President pointed out
that the "News" is now being used as a means of
communication and education as well as news, and
expressed hope that the group at large approved
and appreciated this. This Chairman plans to move
up the deadline for "News" reports to the 10th
instead cf the 15th, of June, September, December,
and March.

Awards Chairman, Mrs. Powell G. Fox, had no
announcements at this time.

Civil Defense Chairman, Mrs. Amos N. Johnson,
noted on3 addition to the supplemental report,
flaga 3 — that Cumberland County Aux. had taken
First Aid and Nursing courses.

Community Health Chairman, Mrs. Robert N.
Creadick, was absent, but sent a suggestion
through Mrs. Hitch that the committees of Com-
munity Health and Community Service might well
be combined. This will come up for consideration
later, after due study.

Legislation Chairman, Mrs. W. Jack Hunt, ex-
pressed great appreciation for the work done this
year, work that she considered outstanding.

Memorials Chairman, Mrs. W. P. Richardson, re-
ported the deaths of eight members during the
year.

Paramedical Careers Recruitment Chairman,
Mrs. A. J. Crutchifeld, reminded us that this com-
mittee's name will probably be changed to Health
Careers. This will come up at the National meet-
ing for decision, and we will conform to the Na-
tional designation.

Program Committee Chairman, Mrs. D. S. Cur-
rie, Jr., had no report except to say that there will
be a change in report forms next year.

S.A.M.A. Chairman, Mrs. W. Reece Berryhill,
reported that the two main active areas in this
field are Forsyth-Stokes and Durham-Orange, and
the one officially affiliated group at this time is at
Duke.

Today's Health Chairman was absent, but Mrs.
Garrard reported that we had at least 450 sub-
scriptions above those reported before Project 60
was announced, and more were expected. At this
point, Mrs. Gastineau discussed Project 60 briefly,
saying that the national organization was very
grateful for these extra subscriptions, and that she
thought probably N. C. did best of all in this.

Representatives to other state organizations
were recognized.

Nominating Committee for 1960-61, in accord-
ance to the By-Laws, was appointed as follows:

1. Mrs. R. L. Garrard, 8th District

2. Mrs. Lenox Baker, 6th Distict

3. Mrs. Baxter Troutman, 9th District

4. Mrs. Eugene Clayton, 10th District

5. Mrs. W. E. Keiter, 2nd District
and two alternates:

1. Mrs. Phil Ban-inger, 7th District

2. Mrs. Donnie Royal, 3rd District
Old Business

Mrs. Garrard commented on the five Recommen-
dations, made and passed at the Fall Board Meet-
ing, which will be presented to House of Delegates.

106

NORTH CAROLINA MEDICAL JOURNAL

September, I960

New Business

The President reminded us of the Nominating
Committee changes, published in the Auxiliary
News, and had this read in full by By-Laws Com-
mittee Chairman, Mrs. Tolbert Wilkinson, (at-
tached) A motion was made, seconded and passed,
to adopt these changes.

Mental Health Chairman, Mrs. A. M. Lang, was
asked to read the following recommendation ap-
proved at the Fall Board Meeting:

"The Mental Health Committee, as authorized
by the Board at the Fall Board Meeting on Sep-
ember 9, has been working through the details of
setting up a new Mental Health Project for the
Auxiliary. We are prepared at this time to make
the following recommendations:

"That the Auxiliary to the Medical Society of
the State of North Carolina set up an Endowment
Fund in the minimum amount of $10,000, the pro-
ceeds of which are to be used by the Psychiatric-
Department of Memorial Hospital, University of
North Carolina, for research and training pur-
poses. The money is to be disbursed by the Treas-
urer annually, and is to be used at the discretion of
the Director of the Department of Psychiatry for
any needed purpose in the field of research, in the
training of psychiatric personnel, or in the care
of patients maintained in the hospital for training
and research purposes. The Auxiliary does not wish
to dictate how this money will be used, but will
wish to have an annual report on how the money
has been spent. It will take several years to build
up sufficient funds to be of much value, and it is
understood that the Auxiliary's financial contribu-
tion may be added to existing funds for research
or training projects.

"A Chairman is to be appointed to handle this
new Mental Health Endowment Fund, and she will
work under the 2nd Vice-President (Chairman of
Activities). An amendment to the By-Laws, Arti-
cle VI, Section 4 and Article VIII, Section 3(b)
and Section 4, will be necessary. Additions will be
required to Article XI and Article XIV, Section 3.

"It is noted that there is a very urgent need for
funds such as the new Mental Health Endowment
Fund would provide. The assistance of the Auxil-
iary has been requested, the Advisory Committee
of the State Medical Society has expressed its
wholehearted support. It is further noted that the
Yoder Bed Endowment Fund is essentially com-
pleted, and the Auxiliary is ready to undertake a
new long-term project."

The name of the fund shall be the Auxiliary to
the N. C. Medical Society Mental Research Fund."

The motion, formed from the first sentence,
second paragraph of above quote, was made,
seconded, and passed.

At this point, Mrs. W. Jack Hunt, Legislation
Chairman, requested the floor, to express her per-
sonal appreciation and pleasure in working this
year with our wonderful President, Mrs. Garrard.
This was soundly appoved by the group with great
applause.

Mrs. Garrard then introduced Mrs. Frank Gas-
tineau, President, Auxiliary to the American Med-
ical Association. Mrs. Gastineau said that she
picked N. C. to visit because she wanted to pay
tribute to the Auxiliary that was the "best organ-
ized in the United States". She pointed out that
we have 80r;'r of potential membership, and Arkan-
sas is the only other state that has as much, but
it is much smaller. Among other things, she em-
phasized that the main thing we MUST do is to
keep up with current legislation, and that we must
try to reverse the trend of reckless government

spending, and the gradual limiting of our freedoms.
After her inspiring message, the meeting was

adjourned.

Mrs. H. D. Riddle
Recording Secretary

Mrs. R. L. Garrard

President

Date: June 3, 1960

House of Delegates Annual Meeting — May 10, I960

The 37th Annual Meeting of the House of Dele-
gates of the Auxiliary to the Medical Society of
the State of North Carolina met in the Virginia
Dare Room at the Hotel Sir Walter, Tuesday, May
10, 1960, at 9:00 A.M. Mrs. R. L. Garrard, Presi-
dent, called the meeting to order, and the invoca-
tion was given by Mrs. William P. Richardson. A
motion was made, seconded, and passed, to dis-
pense with the Roll Call and the leading of the
Minutes.

The Convention Chairman, Mrs. Paul E. Simp-
son, welcomed the group to Raleigh, asked us to
please check programs again to be sure about the
bus schedules for lunch and the tea, and reminded
us that the hour for the Banquet was to be 6:30
promptly.

Mrs. Garrard expressed appreciation to Mrs.
Simpson and her Convention hostesses for the
hours of hard work and preparation they had
spent.

At this point, in the absence of the 1st Vice-
President, the President asked Mrs. Donnie Royal,
a past President, to take the chair, so that she
might give her President's Report (attached),
which was somewhat of a precis of the report
given with other annual reports, and essentially
the same report she had given to the Medical So-
ciety House of Delegates.

Report of Officers

Mrs. Paul McCain, Chairman of Past Presidents,
introduced those Past Presidents who were pre-
sent, 16 in number, as follows:

Mrs. Paul P. McCain, Wilson

Mrs. A. Byron Holmes, Fairmont

Mrs. William P. Knight, Greensboro

Mrs. Charles P. Eldridge, Raleigh

Mrs. Charles F. Strosnider, Goldsboro

Mrs. Sidney Smith, Raleigh

Mrs. Robert A. Moore, Winston-Salem

Mrs. Karl B. Pace, Greenville

Mrs. W. Reece Berryhill, Chapel Hill

Mrs. B. Watson Roberts, Durham

Mrs. Roscoe McMillan, Red Springs

Mrs. G. M. Billings, Morganton

Mrs. P. G. Fox, Raleigh

Mrs. R. D. Croom, Jr., Maxton

Mrs. Donnie Royal, Salemburg

Mrs. Paul Johnson, Winston-Salem

Mrs. Paul Johnson, 1st Vice-President, intro-
duced District Councilors, who in turn introduced
County Presidents and Presidents-Elect who were
present, (see attached program) NOTE — 9th Dis-
trict will soon have one new county organization,
Davidson, and with the organization of Duplin
County, the 3rd District will now be 100%.

2nd Vice-President, Mrs. Charles D. Thomas,
thanked the group for all gifts to Sanatoria Bed
guests, and for cooperation throughout the year-.
She then introduced the Sanatoria Bed Chairmen,
none of whom were present, and Student Loan
Fund Chairman, Mrs. Roscoe McMillan. Mrs. Mc-
Millan thanked the various counties for their in-
terest and work, and stated that this was certain-
ly the best year yet for the Student Loan Fund.

September, 1960

AUXILIARY TRANSACTIONS

407

Other officers were recognized — Recording Secre-
tary, Mrs. H. D. Riddle; Corresponding Secretary,
Mrs. Marvin McRae; Treasurer, Mrs. W. Ralph
Deaton, Jr. Mrs. Deaton at this po nt noted one
explanation of the Financial Statement. (See at-
tached form)

Committee Chairmen were recognized according
to the mimeographed agenda.

Civil Defense Chairman Mrs. Amos Johnson,
asked everyone to pick up Civil Defense material
outside, to take home, and said some of this ma-
terial would be available in the packets at the
Fall Board Meeting-.

Memorials Chairman Mrs. William P. Richard-
son asked the group to stand in tribute to the
eight deceased members, and read the names. (See
Memorial Service Minutes.)

Representatives to other state organizations
were recognized. (See Program)

Treasurer, Mrs. W. R. Deaton, Jr., presented the
tentative budget, with three changes. (See Finan-
cial Committee Minutes) The motion was made by
Mrs. Deaton, seconded by Mrs. Marvin McRae, and
passed, to accept this budget.

Old Business

The President asked the Recording Secretary to
read six recommendations from the Board of Di-
rectors, to be voted upon separately, as follows:

1. That, to avoid duplication, the Program Com-
mittee and the Radio TV and Movies Committee
be combined, this combining- of committees to be-
come effective at the end of the present Chairmen's
terms, May, 1961. Further recommended that the
section on Committees in the By-Laws, Article
XIV, Section 2, be amended accordingly. Motion to
accept was made by Mrs. Lawrence Owsley, sec-
onded by Mrs. A. T. Melero, and carried.

2. That the Today's Health Committee be dis-
continued at the end of the present Chairman's
term, May, 1961, since the National Auxiliary had
discontinued the sale of Today's Health Magazine
as a major project. Further recommended that this
Committee be deleted from the By-Laws, Article
XIV, Section 2. Motion was made by Mrs. Roy M.
Smith, seconded by Mrs. J. F. McGowan, and was
passed.

3. That the qualifications for the office of Pres-
ident of the Auxiliary to the Medical Society of
the State of North Carolina shall be more clearly
defined, stating that the President must have
served her County Auxiliary as president, and
must have served on the State Board of Directors
for a period of three (3) years, as an officer, com-
mittee chairman, councilor, or any combination of
these. Motion was made by Mrs. A. Byron Holmes,
seconded by Mrs. C. M. Norfleet, and was passed.

4. That the duties of the President-Elect be more
clearly defined, and these shall include the prepar-
ation and typing of the Master Lists of all county
Auxiliary officers and chairmen, with specific-
breakdowns for Councilors, Committee Chairmen
and Treasurer; she shall keep up to date the card
file of all Auxiliary members in the State, record-
ing- any change in the member's status, offices held,
etc.; and that she be charged with the responsi-
bility of conducting the Workshop sessions held at
the Fall Board Meeting each year, working in
close cooperation with the President. It is to be
noted that the President-Elect has been carrying-
out all these functions, but this recommendation
is intended to include them in her official duties so
that she may more fully prepare herself for the
office of President. Motion was made by Mrs. Paul
Johnson, seconded by Mrs. W. P. Richardson, and
was passed.

5. That a complete revision of the By-Laws be
undertaken, beginning in 1960, with special refer-
ence to the duties of officers, line of succession,
etc.; this is to be undertaken to incorporate the
various changes outlined in previous Recommen-
dation of the Executive Committee, to facilitate the
work of the State Auxiliary, and to take advantage
of valuable suggestions made by the National Aux-
iliary. It is suggested that the By-Laws Commit-
tee work in close cooperation with the Legal De-
partment of the State Medical Society. Motion was
made by Mrs. A. T. Melero, seconded by Mrs. Bax-
ter Troutman, and was passed.

New Business

The Recording Secretary read the following
recommendation which had been published in
"Auxiliary News":

6. The Executive Committee of the Aux. to the
Medical Society of the State of N. C, in accord-
ance with the By-Laws, presents the proposed
changes in the By-Laws, subject to the approval
by vote of the House of Delegates: Section 5 —
There shall be a Nominating- Committee consisting
of five members and two alternates, as follows:

a. Two of the five members shall be past pres-
idents, with the immediate past president auto-
matically becoming a member of the Nominating
Committee and serving as Chairman.

b. The remaining members shall be elected and
no two may come from the same district.

c. The Nominating Committee shall be elected
at the Board Meeting immediately preceding the
Annual Meeting.

d. The Nominating Committee shall confer and
come to an agreement before asking anyone to
serve, and shall obtain the consent of all nominees
before presenting their names. Nominations shall
be permitted from the floor.

The above change combines Section 5 and Sec-
tion 6 of the By-Laws, and places the immediate
past president on the Nominating Committee, to
serve as Chairman, and includes one additional
past president. Motion was made by Mrs. Z. F.
Long, seconded by Mrs. Lawrence Owsley, and
was passed.

The President then asked the Recording Secre-
tary to read in full the report and recommenda-
tions from the Mental Health Committee (See
Minutes of Board of Directors Meeting). Motion
was made by Mrs. Roscoe McMillan, seconded by
Mrs. Henry Sikes, and was passed. (During dis-
cussion, before above motion was passed, Mrs. Gar-
rard replied to a question, that the reason the
University of N. C. was chosen to handle this en-
dowment fund, was that it is a state-supported
university, and we are a state organization.)

Immediately after motion was carried, Mrs. Roy
Smith, Guilford-Greensboro Branch, asked for the
floor. She said that her county Auxiliary — and Mrs.
Garrard's — wanted to contribute $100.00 as the be-
ginning of this Mental Health Endowment Fund.
The President very graciously accepted this con-
tribution.

The Recording- Secretary was then asked to read
in full a suggestion from the 1st Vice President,
Mrs. Paul Johnson:

"As 1st Vice President in charge of Membership
and Organization, I would like to emphasize the
importance of this assignment. Increasing mem-
bership is vital to the strength of the Auxiliary,
and learning- more about the membership and
various problems is a challenge. Much thought and
imagination are required in fulfilling the func-
tions of First Vice President. It has become in-
creasingly evident that our officer alignment or
'Chain of Command' should be made to conform

in,;

NORTH CAROLINA MEDICAL JOURNAL

September, I960

with our National Auxiliary, namely the First
Vice-President is an elected officer, frequently suc-
ceeding as President-Elect and President. Thus the
duties of First Vice-President could be a forerun-
ner to the office of President. In our State Auxil-
iary, this office is automatically filled by the out-
going President. It is obvious that a thorough
knowledge of Membership and Organization would
render a President much more effective in her
service to the Auxiliary, and she would find this
experience more helpful before her term as pres-
ident than after it. Therefore, as immediate Past-
President,I suggest that the First Vice-President in
charge of Membership and Organization become a
duly nominated and elected officer each year. This
will necessitate a change in the By-Laws, Article
5, Section 2."

(Further) If the First Vice-President is to be-
come an Elected Officer, then we should consider
that the out-going President become a Director,
serving for one year, and she will have full re-
sponsibility for preparing Report Forms for the
use of Committee Chairmen. These forms are to
be prepared and presented to the State President
for inclusion in the Packets at the Fall Board
Meeting. This would eliminate confusion, incom-
plete or inadequate report forms, and will make
our National reporting much easier."

Mrs. Garrard stated that this suggestion would
come up at the Fall Board Meeting for considera-
tion as a recommendation.

She also mentioned that she had asked Dr.
Reece, President of the Medical Society, to bring
up, if possible, a recommendation before the Med-
ical Society, to change the name of the society to
"N. C. Medical Society", so that our own official
title would be less unwieldy.

In the absence of any other business, the meet-
ing was then adjourned, and a coffee and Coca-
Cola break was enjoyed.

Mrs. H. D. Riddle
Recording Secretary

Mrs. R. L. Garrard

President

Date: June 3, 1960

General Meeting
May 10, 1960

The 37th Annual General Meeting of the Aux-
iliary to the Medical Society of the State of North
Carolina convened at 10:30 A.M., in the Virginia
Dare Room of the Hotel Sir Walter, Raleigh, with
the President, Mrs. R. L. Garrard presiding. The
Invocation was given by Mrs. William P. Knight,
followed by the Auxiliary Pledge of Loyalty, with
all participating.

A most gracious welcome was given by Mrs.
Thomas B. Wilson, President of Wake County
Auxiliary, followed by a humorous and apprecia-
tive response by Mrs. Roy M. Smith, President of
Guilford-Greensboro Auxiliary.

The President also expressed her gratitude for
the tremendous work of preparation that our hos-
tesses had done.

The Convention Chairman, Mrs. Paul Simpson,
reminded us of the bus schedules for the luncheon
and the tea. She also stated that at last count,
here were 255 Auxiliary members registered.
_ Mrs. Garrard regretted that Mrs. Frank Gas-
tineau, President of the Auxiliary to the American
Medical Association, had had to leave the previous
night, so could not be with us. She then introduced
other distinguished guests: Mrs. John M. Chenault,
President of the Auxiliary to Southern Medical
Association; Miss Martha Adams, President of the

N. C. State Nurses' Association, who spoke brief-
ly and extended greetings; Miss Agnes Campbell.
1st Vice-President (substituting for Miss Sue Ker-
ley, President) of N. C. League for Nursing; Mrs.
Mary K. Kneedler, Chief of Public Health Nursing,
N. C. Public Health Department; Dr. Jean Brooks,
member of the Advisory Committee of the Med-
ical Society, was not present, nor were Mrs. An-
nette Boutwell, Mrs. James Barnes, nor Mrs. Wil-
liam Hilliard.

Dr. Roscoe McMillan, Chairman of the Advisory
Committee, was unable to be present, as was Dr.
John Reece, President of the Medical Society. Dr.
Reece sent greetings in the form of a letter, which
was read by the Recording Secretary. (Attached to
Minutes of Board of Directors' Meeting)

Stanly County President, Mrs. George E. Eddins,
Jr., asked her local AMEF Chairman, Mrs. L. H.
Harris, to tell the group about a money-making
project for AMEF that they were planning. Mrs.
Harris said, however, that these plans were still
incomplete. Mrs. Garrard asked that when they
had worked out the details, they bring them to the
Fall Board Meeting, so that we might all have the
benefit of any new ideas.

The President at this time pointed out that this
was National Hospital Week.

She then introduced, for a delightful entertain-
ment, a chorus from the Guilford County Auxil-
iary— Greensboro Branch, 22 singers who were all
Auxiliary members. The group was directed by
Mrs. John W. Allgood, and accompanied by Mrs.
H. B. Perry. Their numbers were "Get Me to the
Church on Time", "I Could Have Danced All
Night", "Three Blind Mice", "Lady of Spain",
"The Cuckoo Clock", and "All the Things You
Are". This was an unusually good rendition, and
all the more enjoyable because of the singers' be-
ing Auxiliary members.

Mrs. Karl B. Pace introduced the Past Presi-
dents, of whom the following 16 were present: Mrs.
Paul P. McCain, Wilson; Mrs. A. Byron Holmes,
Fairmont; Mrs. William P. Knight, Greensboro;
Mrs. Charles P. Eldridge, Raleigh; Mrs. Charles
F. Stronsnider, Goldsboro; Mrs. Sidney Smith,
Raleigh; Mrs. Robert Moore, Winston-Salem; Mrs.
Karl B. Pace, Greenville; Mrs. W. Reece Berryhill,
Chapel Hill; Mrs. B. Watson Roberts, Durham;
Mrs. Roscoe McMillan, Red Spring; Mrs. G. M.
Billings, Morganton; Mrs. Powell G. Fox, Raleigh;
Mrs. R. D. Croom, Jr., Maxton; Mrs. Donnie M.
Royal, Salemburg; Mrs. Paul Johnson, Winston-
Salem.

Mrs. Garrard then introduced Mrs. John M. Che-
nault, President, Auxiliary to Southern Medical
Association, of Decatur, Alabama. She reported
that there are 948 N. C. doctors now members of
the Southern Medical Association, and suggested
that the gift of a membership for our husbands
would be good idea for any occasion. The annual
convention of SMA will be in St. Louis on October
31. She advised that "Love is the most essential
gift a doctor's wife should have, both for our fel-
low man, and for the profession of medicine," and
that it would help us to fight off the "demons of
jealousy, selfishness, and criticism." She finished
her inspiring talk with the quotation, "It is not
the height of the mountain that deters the climber,
but rather the tack in his shoe", and urged us to
"get the tacks out".

Mrs. Garrard called upon Mrs. James F. Rein-
hardt. Community Service Chairman, who was in
charge of the program, "We Did It Like This".
Mrs. Reinhardt pointed out that although the
mimeographed Annual Reports enable us to get a
good overall idea of the work being done, some-

September, 1960

AUXILIARY TRANSACTIONS

409

times perhaps we miss the personal enthusiasm
and intimacy of the county workers. So this pro-
gram was planned to let some of these workers
tell us how they had accomplished certain goals.
These representatives were from both large and
small organizations.

For AMEF, Mrs. A. B. Croom, President of
Guilford County-High Point Branch, said they in-
creased their contribution from $50.00 to $150.00,
simply by increasing their dues $2.00 each.

For Doctors' Day, Alamance-Caswell Auxiliary
(small), as told by Mrs. J. H. Hawkins, President,
gave their own production of "Gigi", with words
and parodies borrowed from Forsyth-Stokes' per-
formance last year, and augmented to suit their
own group.

For Doctors' Day Guilford County-Greensboro
Branch (over 50 members), as told by Mrs. Roy
M. Smith, President, had a buffet dinner in the hall
of one of the new churches, and entertainment was
provided by the Chorus from their own Auxiliary.
The retired doctors of the county were special
guests of honor.

Mrs. W. L. Kirby, from Forsyth-Stokes Auxil-
iary, told of their work in Mental Health, with
special reference to their work with the aged. Mrs.
Chalmer R. Carr, Mecklenburg Auxiliary, told of
their Paramedical Careers Recruitment work,
which they worked in with a Hospital Career Day,
for local students, etc. Mrs. H. M. Wilson (sub-
stituting for Mrs. Len D. Hagaman), President-
Elect of Watauga County, described their methods
of earning money for the Student Loan Fund.
Mrs. James E. Ribet, substituting for Mrs. J. Tay-
lor Vernon, Burke County, told about their fund
raising for the Yoder Bed Endowment Fund.

After this informative program, Mrs. Garrard
asked Mrs. Powell G. Fox to present the awards
for the year's work. Mrs. Fox then said that the
program we had just heard had told us mostly
where the awards were going. They were as fol-
lows:

1. AMEF — The Shirley Kingsbury Fox "Talents
for Service Award", given by Mrs. P. G. Fox —
$100.00.

For highest per capita contribution — Guilford-
High Point Branch

Also, certificates to Forsyth-Stokes for largest
contribution, and Cabarrus for outstanding in-
crease.

2. Doctors' Day — given by Mrs. Harvey C. May
County with over 50 members — $5.00 — Guilford-
Greensboro Branch

County with under 50 members — $5.00 — Ala-
mance-Caswell

3. Paramedical Careers Recruitment — the Rachel
Taylor Award, given by Mrs. Almon R. Cross
County with over 30 members — $5.00 — Mecklen-
burg

County with under 30 members — $5.00 — Anson

4. Dues 100% paid (first) — given by Mrs. G. M.
Billings

Award — $5.00 — to Union County
Honorable mention to Bladen County

5. Research and Romance of Medicine — given by
Mrs. Donnie Royal — no candidates for this award,
so it will be held over till next year.

6. Student Loan Fund — given by Mrs. Roscoe D.
McMillan and Mrs. B. Watson Roberts— $10.00— to
Watauga County

7. Mental Health — given by Mrs. Karl B. Pace—
$5.00— to Forsyth- Stokes

8. Yoder Bed Endowment Fund — given by Mrs.
R. D. Croom, Jr.— $5.00— to Burke County

9. County Yearbook — given by Mrs. Baxter S.
Troutman — $5.00 — to Robeson County

10. The President's County Achievement Award
for the Best Overall Work — given by Mrs. R. L.
Garrard— $10.00— to Gaston County

The President now asked for the report of the
Nominating Committee, and Mrs. A. Byron
Holmes, Chairman, gave it as follows:

President-Elect — Mrs. George T. Noel, Kannap-
olis

Second Vice-President — Mrs. James F. Rein-
hardt, Durham

Treasurer — Mrs. W. Ralph Deaton, Jr., Greens-
boro

The floor was then opened to nominations, of
which there were none. The motion was made by
Mrs. Byron Holmes to accept the slate as read,
seconded by Mrs. Lawrence Owsley, and passed
unanimously.

Mrs. Paul P. McCain, assuming her traditional
role, then installed the following officers for 1960-
61: President, Mrs. J. M. Hitch; President-Elect,
Mrs. George T. Noel; 2nd Vice-President, Mrs.
James F. Reinhardt; Treasurer, Mrs. W. Ralph
Deaton, Jr.

Mrs. Garrard, with congratulations, presented
the gavel to Mrs. Hitch, who made a few inaug-
ural remarks, and pinned the Past President's Pin
on Mrs. Garrard. Mrs. Hitch announced that the
Fall Boad Meeting will be in Raleigh on September
7. She also recognized Mrs. E. Clarence Judd, who
was our Treasurer for 20 years. Final registration
was 338.

With no other business, the meeting was ad-
journed.

Mrs. H. D. Riddle
Recording Secretary

Mrs. R. L. Garrard

President

Date: June 3, 1960

Report of the Treasurer

The Audited Report of the Treasurer's records
for the year 1959-1960 is submitted herewith, re-
ceipts and disbursements having been recorded
and transactions made in accordance with the By-
laws.

A membership of 2,279 was attained in 1959-
1960 which is 14 less than last year due to two
counties becoming inactive.

The financial picture of the Auxiliary is stable.
A change has been made in the handling of the
Contingency Fund which was in the checking ac-
count. The Auxiliary now holds a savings account
repi-esenting share interests of two thousand dol-
lars ($2,000) in the Home Federal Savings and
Loan Association of Greensboro. We will receive
4f/r interest on this amount annually.

This year we were notified by the United States
Treasury that two of our bonds in the Stevens En-
dowment Fund were to mature in July 1960 and
that we were to be given the opportunity to rein-
vest these bonds in United States marketable
bonds which would yield 4% % interest. We took
advantage of the opportunity although up to this
time we have only invested in savings bonds.

At this time we are $534.26 short of completing
the $10,000 Paul Allison Yoder Endowment Fund.
We have $7500 in Savings Bonds and $1,965.74 in
the Home Federal Savings and Loan Association
of Greensboro.

During the year we issued student loans in the
amount of $2500 which brings the total of our
loans to $5000. We have already received requests
for more loans, which if issued, will exhaust our
Student Loan Fund until we receive more contri-
butions or paid up loans.

(Continued on page 414)

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414

NORTH CAROLINA MEDICAL JOURNAL

September, I960

We were delighted to set up another endowment
fund called the Mental Research Fund. Greensboro
Branch of Guilford County Medical Auxiliary
started the fund off by contributing $100.00. This
has been placed in a savings account in Home
Federal Savings and Loan Association.

My job as Treasurer was considerably easier
this year due in part to having now had some ex-
perience at the job and in part to recommenda-
tions from the Auditor who suggested changes that
made the bookkeeping easier.

As experienced the first year as Treasurer, hav-
ing had the opportunity of working with every
member of the Executive Board has been a very
worthwhile experience, and I would like to thank
them for all their help and cooperation. My thanks
go also to Mr. James T. Barnes and to each mem-
ber of his staff for their help at the Convention
and to Dr. R. D. McMillan and Dr. Jean Brooks
for their interest in the welfare and activities of
the Auxiliary.

ROSTER OF MEMBERS
1960-1961

HONORARY MEMBERS

Holmes, Mrs. Andrew Bvron

112 Church Street Fairmont

Judd, Mrs. E. Clarence

2108 Woodland Ave Raleigh

Knight, Mrs. William Pinkney

720 Summit Ave Greensboro

McCain, Mrs. Paul Presslv, Route 1, Box 31, Wilson
Taylor, Mrs. Frederick R.

1113 Johnson St High Point

LIFE MEMBERS

Britt, Mrs. James Norment

209 E. 10th St Lumberton

Eldridge, Mrs. Charles Patterson,

1621 St. Mary's St Raleigh

Freeman, Mrs. Jere David

527 Forest Hills Dr Wilmington

Johnson, Mrs. George W.

1803 Chestnut St Wilmington

Murray, Mrs. Robert Lebby, Box 216 Raeford

Thomas, Mrs. Charles Darwin Black Mountain

Yoder, Mrs. Paul A.

1919 Robin Hood Rd Winston-Salem

MEMBERS

Abbott, Mrs. Robert West

State Hospital Goldsboro

Abernethy, Mrs. Joseph Whitner

343 Second St., N. W Hickory

Abernethy, Mrs. Paul McBee

510 Count-y Club Dr Burlington

Acuff, Mrs. Calvin Clifford Glen Alpine

Adair, Mrs. William Edward, Jr.

502 East G St Erwin

Adams, Mrs. Carlisle

1500 Meadowood Lane Charlotte

Adams, Mrs. Carlton Noble

2930 Windsor Rd Winston-Salem

Adams, Mrs. Charles H Grover

Adams, Mrs. Charles Patrick

1907 Forest Hill Dr Greenville

Adams, Mrs. Harley Stewart

432 Carolina Circle Winston-Salem

Ader, Mrs. Ottis Ladeau Walkertown

Aderholt, Mrs. Marcus Lafayette, Jr.

1013 Rotary Dr High Point

Adkins, Mrs. Trogler Francis

2810 Dogwood Rd Durham

Agner, Mrs. Marshall Edward, Box 157, Cherry ville
Agner, Mrs. Rov Augusta, Jr.

400 Merritt Ave Salisbury

Akeson, Mrs. Wayne H.

21 Flemington Rd. ..... Chapel Hill

Albergotti, Mrs. Julian S., Jr.

412 Livingston Dr Charlotte

Alderman, Mrs. Allison Mondonville, Jr.

1311 Westfieki Ave Raids"..

Alderman, Mrs. Edward H., Drawer P, Four Oaks
Alexander, Mrs. Eben, Jr.

521 Westover Ave Winston-Salem

Alexander, Mrs. James Moses

255 Colville Rd Charlotte

Alexander, Mrs. James Porter

1910 Beverly Dr Charlotte

Alexander, Mrs. Joseph Black

1001 N. Walnut St Lumberton

Alexander, Mrs. Lawrence M Sanford

Alexander, Mrs. Sydenham B.

511 Dogwood Dr Chapel Hill

Alexander, Mrs. William McKinley

1110 Fourth Ave., West Hendersonvillc

Allen, Mrs. Charles Insley, Sr Wadesboro

, Allen, Mrs. George Calvin,

206 E. 17th St Lumberton

Allen, Mrs. John O. Henrv, 201 Broad St., Marion

Allen, Mrs. LeRoy, 1603 Ridge St Raleigh

Allgood, Mrs. John William, Jr.

105 Knolhvood Dr Greensboro

Alsup, Mrs. William Byrn, Jr.

261 Westview Dr Winston-Salem

Altany, Mrs. Franklin Edward

822 Longbow Rd Charlotte

Alvea, Mrs. Edwin Pascal

3102 Devon Rd., Hope Valley Durham

Ames, Mrs. Richard Haight

2316 Princess Ann St Greensboro

Anders, Mrs. McTyeire Gallant

416 W. 5th Ave Gastonia

Anderson, Mrs. Elbert Carl

4934 Oleander Dr Wilmington

Anderson, Mrs. John Bascom

294 Vanderbilt Rd Asheville

Anderson, Mrs. Norman LaRue

33 Forest Road Asheville

Anderson, Mrs. William Banks

502 E. Forest Hills Blvd Durham

Andrew, Mrs. John Montgomery

Box 524 Lexington

Andrew, Mrs. Lacv Allen, Jr.

2839 Reynolds Rd Winston-Salem

Andrews, Mrs. Bob Barcus, 503 W. 31st, Lumberton
Andrews, Mrs. George R.

3354 Hampton Road Raleigh

Andrews, Mrs. Leon Polk

2217 Winterlocken Rd Fayetteville

Andrews, Mrs. Robert Jackson

1130 S. Live Oak Parkway Wilmington

Andrews, Mrs. Vernon Liles Mt. Gilead

Anthony, Mrs. Luther Leslie,

1210 Jones St Gastonia

Anthony, Mrs. William Augustus

1203 Belvedere Ave Gastonia

September, 1960

ROSTER OF MEMBERS

415

Antonakos, Mrs. Theodore Danbury

Arena, Mrs. Jay Morris, 2032 Club Brvd.., Durham
Arey, Mrs. John Vincent, 89 Caldwell Dr. Concord
Armistead, Mrs. Drury Branch

1603 E. 6th St Greenville

Armstrong, Mrs. Beverly Welier

1 Armstrong- Drive Charlotte

Arney, Mrs. William Charles,

W. Park Dr. ..._ Morganton

Arnold, Mrs. Jesse Hoyt, Jr.

709 W. Highland Ave Kinston

Arnold, Mrs. Ralph A., 911 Urban Ave., ....Durham
Arrendell, Mrs. Cad Walder, Jr.

500 Merwick CI. Charlotte

Arthur, Mrs. Robert

308 Hinsdale Ave Fayetteville

Arthur, Mrs. Robert Key, Jr.

405 Rolling Rd High Pome

Ashe, Mrs. John Rainey, Jr.

203 Grandview Dr Concord

Ashford, Mrs. Charles Hall

605 Pollock St New Bern

Atkins, Mrs. Stanley Sisco

7 N. Dogwood Rd Asheville

Ausband, Mrs. John Rufus

817 Shoreland Rd Winston-Salem

Ausherman, Mrs. Howard Milton

233 Fenton Place Charlotte

Austin, Mrs. Frederick DeCosta, Jr.

605 Colville Rd „ Charlotte

Averett, Mrs. Leland Stanley, Jr.

1506 Whitehall High Point

Avery, Mrs. Edward Stanley

1824 Meadowbrook Dr Winston-Salem

Aycock, Mrs. Edwin Burtis

Longmeadow Rd Greenville

Aycock, Mrs. James Bernics

110 Maehill Dr Lenoir

Aycock, Mi-s. William Glenn

E. Graham St Mebane

Ayers, Mrs. James Salisbury, Finch St., ....Clinton

Bagby, Mrs. Bathurst Browne, Jr.

17 Highland Rd Asheville

Baggett, Mrs. Joseph Woodrow

365 Valley Rd Fayetteville

Bahnson, Mrs. Edward Reid

2525 Windsor Rd Winston-Salem

Bailey, Mrs. Clarence Whitfield

512 Shady Circle Dr Rocky Mount

Bailey, Mrs. Joseph Peden Hendersonvilie

Bailey, Mrs. Mercer H.

Winslow Acres Elizabeth City

Bailey, Mrs. Robert Carl, 330 Scenic Dr., Concord
Baker, Mrs. Barnwell Rhett

31 Buena Vista Rd Asheville

Baker, Mrs. Herbert Marvin Faith

Baker, Mrs. Horace Mitchell, Jr.

1901 N. Elm St Lumberton

Baker, Mrs. Horace Mitchell, Sr.

703 N. Elm St Lumberton

Baker, Mrs. Larry Duanc

3116 Gardner Park Dr Gastonia

Baker, Mrs. Lenox Ditl

3106 Cornwall Rd., Hope Valley Durham

Baker, Mrs. Roger D.

303 Swift Ave Durham

Baker, Mrs. Thomas Williams

2029 Queens Rd. Charlotte

Baldwin, Mrs. William Edwin, Jr.

Wilmington Rd Whiteville

Ballenger, Mrs. Claude Newton

750 Pee Dee Ave Albemarle

Ballew, Mrs. James Robert

901 Lake Boone Trail Raleigh

Balsley, Mrs. Robert Eugene

825 Crescent Drive Reidsville

Baluss, Mrs. John William, Jr.

2315 Westdale Dr Fayetteville

Bandy, Mrs. William Gaither

601 N. Laurel St Lincolnton

Bandy, Mrs. William Henry

Dogwood Hills Newton

Barden, Mrs. Graham Arthur, Jr.

412 Johnson St New Bern

Barefoot, Mrs. Graham Ballard

120 Forest Hills Dr Wilmington

Barefoot, Mrs. Julius J., Jr.

Morehead Rd New Bern

Barefoot, Mrs. Sherwood Washington

3107 Madison Ave Greensboro

Barefoot, Mrs. William Frederick

Chadbourn Rd Whiteville

Barker, Mrs. Christopher Sylvanus

711 Broad St New Bern

Barnes, Mrs. Frank Edward, Jr.

513 Church St Smithfield

Barnes, Mrs. Henry Eugene, Jr.

528 First Ave., N. W Hickory

Barnes, Mrs. James Allen

2259 Sherwood Dr Winston-Salem

Barnes, Mrs. M. Russell, Jr.

128 Bryan PI Jacksonville

Barnhardt, Mrs. Albert Earl, Box 652, Kannapolis
Barnhill, Mrs. Otha Allen, Box 505, Elizabethtown
Barrett, Mrs. John Milton

805 James St Greenville

Barrick, Mrs. Harry, Jr.

914 Lake Boone" Trail Raleigh

Barrier, Mrs. Henry Webster

1500 Central Dr Concord

Barringer, Mrs. Archie Lipe

Box 278 Mt. Pleasant

Barringer, Mrs. Phil Lewis, Forest Hills, Monroe
Barron, Mrs. John Isaac

508 Riverside Dr _ Morganton

Barry, Mrs. William, 216 Roberts St., Raeford

Barry, Mrs. William Francis, Jr.

1022 Gloria Ave Durham

Bartels, Mrs. Kenneth Garber

312 Regal Hendersonvilie

Bartlett, Mrs. Stephen Russell, Jr.

208 N. Longmeadow Rd Greenville

Bass, Mrs. Beaty Lee

415 S. Ridgecrest Ave Rutherfordton

Bates, Mrs. Harold Bascom

1007 Sherwood Dr Burlington

Batten, Mrs. Hubert Elmore

301 Fairfield Rd ...Fayetteville

Batten, Mrs. Woodrow, 402 Church St., Smithfield
Baylin, Mrs. Georg-e Jay

2535 WrightwTood Ave Durham

Baynes, Mrs. Ralph H Hurdle Mills

Beale, Mrs. Seth McPhsrson, Box 508 Elkin

Beall, Mrs. Lawrence Lincoln

1850 North Elm St Greensboro

Bear, Mrs. Sigmond Aaron

1415 S. Live Oak Parkway Wilmington

Beavers, Mrs. Charles Lee

1110 Sunset Dr Greensboro

Beavers, Mrs. James Wallace

2206 W. Market St Greensboro

Beavers, Mrs. William Olive, Routs 1, McLeansville

Beck, Mrs. J. Montgomery, Route 7, Burlington

Becknell, Mrs. George Franklin, Jr.

Forest Hills Forest City

Beddingfield, Mrs. Edgar Theodore, Jr.

Stantonsburg

Belcher, Mrs. Cecil Cullen, 28 Hilltop, ....Asheville
Belk, Mrs. George Washington

403 W. 6th Ave Gastonia

Bell, Mrs. George Erick, Sr.

1505 W. Nash St Wilson

Bell, Mrs. Ira Eugene

508 6th St., N. W Hickory

Bell, Mrs. Orville Earl

829 Sycamore St Rocky Mount

416

NORTH CAROLINA MEDICAL JOURNAL

September, 10(50

Bell, Mrs. Spencer Alexander

Box 33 Hamptonville

Bellamy, Mrs. Robert Hartlee

Greenway Ave Wilmington

Benbow, Mrs. Edgar Vernon

1411 Reynolda Rd _ ...Winston-Salem

Benbow, Mrs. Edward Perry, Jr.

3809 Fiiendly Road Greensboro

Bender, Mrs. John Joseph Red Springs

Bender, Mrs. John Robert

1166 S. Hawchorne Rd Winston-Salem

Bennett, Mrs. E;nest Claxton

Box 295 Elizabethtown

Bennett, Mrs. Harron Kent Archdale

Bennett, Mrs. Hugh Hammond, Jr.

441 Circle Dr Burlington

Bennett, Mrs. John Northwood

c/o Wilkes General Hospital .North Wilkesboro
Bennett, Mrs. Paul, Jr., 109 S. Andrews, Goldsboro
Bensen, Mrs. Vladimir Basil

Blue Ridge Road Raleigh

Benson, Mrs. John Fisher

710 Gatewood High Point

Benson, Mrs. Norman Oliver

203 E. 19th St Lumberton

Benton, Mrs. George Ruffin, Jr.

207 S. Pineview Ave Goldsboro

Benton, Mrs. Wayne Jefferson

1003 N. Eugene St Greensboro

Berkeley, Mrs. Alfred Rives, Jr.

541 Hempstead Place Charlotte

Berkeley, Mrs. William Thomas, Jr.

1870 Queens Rd., W Charlotte

Berry, Mrs. Francis Xavier

1208 Colonial Ave Greensboro

Berryhill, Mrs. Walter Reece

Box 866, Upper Laurel Hill Chapel Hill

Bertling, Mrs. Marion Henry

2312 Princess Ann St Greensboro

Best, Mrs. Deleon Edward

1504 E. Mulberry St Goldsboro

Best, Mrs. William Ross

1510 Sherwood Dr Burlington

Bethea, Mrs. William Thad Fair Bluff

Betts, Mrs. Wilmer Conrad

3422 Leonard St Raleigh

Biggs, Mrs. Dennis Walter, Jr.

205 West 22 St Lumberton

Biggs, Mrs. John Irvin, 2201 Elm St., Lumberton
Billings, Mrs. Gilbert M., 122 Powe St., Morganton
Bingham, Mrs. Robert Knox, 105 Hardin St., Boone

Bitting, Mrs. Numa Duncan, 34 Oak Dr Durham

Bittinger, Mrs. Charles Lewis

734 Pinewood Circle Mooresville

Bittinger, Mrs. Samuel Moffett

Blue Ridge Rd Black Mountain

Bivens, Mrs. Edward Shirley

601 East St Albemarle

Bizzell, Mrs. James W., Overbrook Drive, Goldsboro
Bizzell, Mrs. Marcus Edward

500 E. Walnut St Goldsboro

Black, Mrs. George William

1566 Queens Rd., W Charlotte

Black, Mrs. John Riley, Jr.

212 Jefferson St Whiteville

Black, Mrs. Kyle Emerson, Acorn Lane, Salisbury
Black, Mrs. Paul Adrian Lawrence

2732 Park Ave Wilmington

Blackmon, Mrs. Bruce Bernard Buie's Creek

Blackwelder, Mrs. Verne Hamilton

323 S. Mulberry St Lenoir

Blair, Mrs. Andrew B.

1220 Queens Rd., W Charlotte

Blair, Mrs. George Walker, Jr.

460 Parkview Dr Burlington

Blair, Mrs. James Samuel

1116 Cumberland Ave Gastonia

Blair, Mrs. Mott Parks Marshville

Blake, Mrs. Damon

645 Kingsbury Circle Winston-Salem

Blanchard, Mrs. George Caswell

1701 Brandon Rd Charlotte

Bland, Mrs. Delmar Earl

289 Canterbury Trail Winston-Salem

Bland, Mrs. William Herbert, 401 West Cary

Blue, Mrs. John Frederick, Brinn Drive, Sanford
Blue, Mrs. Waylon, 2505 Dalrymple Rd., Sanford
Boggs, Mrs. Lawrence Kennedy

2208 Wellesley Ave Charlotte

Bolin Mrs. Grover Cleveland Jr.

Crescent Drive Smithfield

Bolin, Mrs. Lewis Bryant, 111 Will St., ...Mt. Airy
Bolon Mrs. Charles Gordon

4733 Wendover Lane Charlotte

Bolt, Mrs. Conway Anderson, Box 368, Marshville
Bolus, Mrs. Michael, 2220 Wheeler Rd., ...Raleigh
Bond, Mrs. Edward Griffith,

102 Pembroke Circle Edenton

Bond, Mrs. John Pennington

1806 Fairfield Dr Gastonia

Bond Mrs. Vernard Franklin Jr.

340 Buckingham Rd Winston-Salem

Bonner Mrs. John Bryan Havens

1100 Riverside Ave Elizabeth City

Bonner, Mrs. Merle Dumont

203 Kimberly Dr Greensboro

Bonner Mrs. Octavius Blanchard

408 Edgedale Dr High Point

Boone, Mrs. John W., Jr.

826 Monroe St Roanoke Rapids

Boone, Mrs. William Waldo

1001 Gloria Ave Durham

Borden, Mrs. Richard Winstead

1600 E. Elm St Goldsboro

Boren Mrs. Richard Benjamin III

813 N. Bridge St Elkin

Bos, Mrs. John Fremont

1574 Clayton Dr Charlotte

Bostic Mrs. William Chivous, Jr.

535 E. Main St Forest City

Bourgeois, Mrs. Michael

1017 Norwood Ave Durham

Bower, Mrs. Joseph Shelton

1100 N. Queen St Kinston

Bowles, Mrs. Francis Norman

1400 Shepherd St Durham

Bowman, Mrs. Earl L.

1101 N. Walnut St Lumberton

Boyce, Mrs. Oren Douglas, Boyceleyn Rd., Gastonia
Boyce, Mrs. William Henry

939 N. Stratford Rd Winston-Salem

Boyd, Mrs. Basil Manley, Jr.

1816 Maryland Ave Charlotte

Boyes, Mrs. James Gordon, Jr.

1163 Country Club Rd. Wilmington

Boyette, Mrs. Ben Robert, Jr.

1508 E. Palm St Goldsboro

Brabson, Mrs. John Anderson

323 Hempstead PI Charlotte

Bradford, Mrs. George Edwin

444 Roslyn Rd Winston-Salem

Bradford, Mrs. Williamson Ziegler

310 Colville Rd Charlotte

Bradish, Mrs. Robert F.

1712 Raeford Rd Fayetteville

Bradley, Mrs. Harold John

105 W. Brentwood Greensboro

Bradley, Mrs. John David, 5 Ravenna Dr., Asheville
Bradshaw, Mrs. Howard Holt

2837 Reynolds Rd Winston-Salem

Bradsher, Mrs. Arthur Brown

421 Carolina Circle Durham

Bradsher, Mrs. James Donald, Box 168 . .. Roxboro
Brady, Mrs. Charles Eldon, Carthage Rd., Robbins
Brady, Mrs. Walter Morris Morehead City

September, 1960

ROSTER OF MEMBERS

417

Branaman, Mrs. Guy Hewitt, Jr.

915 Williamson Dr Raleigh

Brandon, Mrs. Henry Allen Yadkinville

Brantley, Mrs. Coleman

1803 Wright Ave Greensboro

Brantley, Mrs. Julian Chisolm, Jr.

1507 Lafayette Ave Rocky Mount

Brantley. Mrs. Julian Thweatt

1500 Independence Rd Greensboro

Bream, Mrs. Charles Anthony

211 McCauley St Chapel Hill

Breeden, Mrs. William Henry

1524 Morganton Rd Fayetteville

Brenizer, Mrs. Addison Gorgas, Jr.

1301 Providence Rd Charlotte

Bressler, Mrs. Bernard, 2700 Circle Dr., Durham

Brewer, Mrs. James Street Roseboro

Brian, Mrs. Earl Winfrey

2111 White Oak Rd Raleigh

Brice, Mrs. George Wilson, Jr.

3961 Arbor Way Charlotte

Bridger, Mrs. Dewey Herbert Bladenboro

Bridges, Mrs. Dwight Thomas Lattimore

Briggs, Mrs. Henry Harrison, Jr.

323 Vanderbilt Rd Asheville

Brigman, Mrs. Paul Hamer

1005 College Dr High Point

Brinkhous, Mrs. Kenneth Merle

Box 1020 Chapel Hill

Brinn, Mrs. Thomas Preston

105 Front St Hertford

Bristow, Mrs. Charles Oliver

504 Fayetteville Rd Rockingham

Britt, Mrs. Tilman Carlisle, Jr.

130 Rawley Ave Mt. Airy

Britt, Mrs. Walter S.

Veterans Hospital Fayetteville

Brittain, Mrs. Lowell Ellis Huntersville

Brockmann, Mrs. Harry Lyndon

912 Fairway Dr High Point

Brooks, Mrs. Ernest Bruce

2853 Bitting Rd Winston-Salem

Brooks, Mrs. Frederick Philips

Greenville Blvd Greenville

Brooks, Mrs. Martin Luther, Box 141 ...Pembroke
Brooks, Mrs. Ralph Elbert

1303 Rainey St Burlington

Brooks, Mrs. William Lester, Jr.

2110 Queens Rd., W Charlotte

Broughton, Mrs. Arthur Calvin, Jr.

3008 Eton Rd Raleigh

Broun, Mrs. Matthew Singleton

606 Roanoke Ave Roanoke Rapids

Brouse, Mrs. Ivan Edwin

Masonboro Sound Wilmington

Brown, Mrs. Alan Reid .Waynesvilie

Brown, Mrs. Charles William

227 Fenton Place Charlotte

Brown, Mrs. Frank Reid

1103 Country Club Dr Greensboro

Brown, Mrs. George Wallace, Jr Waynesvilie

Brown, Mrs. Gerald Joseph Westfield

Brown, Mrs. Ivan W., Jr., 1709 Vista Dr., Durham
Brown, Mrs. James Walter, Jr.

33 Grandview Dr Concord

Brown, Mrs. Kermit English

Chunns Cove Rd Asheville

Brown, Mrs. Landis G Southport

Brown, Mrs. William Thomas

1308 Pine St Laurinburg

Bruce, Mrs. James Crawford

2902 Dublin Greensboro

Brunson, Mrs. Edward Porcher

804 Pee Dee Ave Albemarle

Bruton, Mrs. Charles Wilson Troy

Bryan, Mrs. Thomas R., Jr.

Finley Park _ North Wilkesboro

Buffaloe, Mrs. William Joseph

906 Tate Dr Raleigh

Bugg, Mrs. Charles Paulett

320 W. Drewry Lane _...Raleigh

Bugg, Mrs. Everett I., Jr.

1544 Hermitage Ct Durham

Buie, Mrs. Roderick Mark, Sr.

119 Kensington Rd Greensboro

Buie, Mrs. Roderick Mark, Jr.

108 Elgin Place Greensboro

Bullock, Mrs. Duncan Douglas, Sr Rowland

Bumgarner, Mrs. John Reed

2101 Mimosa Dr Greensboro

Bunce, Mrs. Paul Leslie, Route 3 Chapel Hill

Bundy, Mrs. James Bizzell

433 McRae Dr Fayetteville

Bundy, Mrs. William Lumsden

Finley Park North Wilkesboro

Bunn, Mrs. David Glenn, Maple St Whiteville

Bunn, Mrs. Richard Wilmot

411 Plymouth Ave Winston-Salem

Burleson, Mrs. Robert Joe

36 Elk Mountain Scenic Hwy Asheville

Burnett, Mrs. Charles Hoyt

Laurel Hill Road Chapel Hill

Burnett, Mrs. Thomas J. M.

4756 Stafford Circle Charlotte

Burnette, Mrs. Harvey Loraine, Jr Morven

Burns, Mrs. Joseph Eugene

41 Ingleside Dr Concord

Burns, Mrs. Stanley Sherman, Jr.

2312 Pembroke Ave Charlotte

Burt, Mrs. Richard Lafayette

2801 Robin Hood Rd Winston-Salem

Burwell, Mrs. John Cole, Jr.

110 Homewood Dr Greensboro

Busby, Mrs. George Francis

Confederate Ave Salisbury

Busby, Mrs. Julian, 401 Idlewood Dr., Kannapolis
Busby, Mrs. Trent, 530 Confederate Ave., Salisbury
Busse, Mrs. Ewald W.

1423 Woodburn Rd Durham

Butler, Mrs. Radford Norman

810 Clovelly Rd Winston-Salem

Butler, Mrs. Raymond Kenneth Waynesvilie

Byerlv, Mrs. Frederick Lee

2000 Robin Hood Rd Winston-Salem

Byerly, Mrs. James Hampton, 620 Carr St., Sanford
Byerly, Mrs. Wesley Grimes, Jr.

546 Sixth St., N. W Hickory

Byerly, Mrs. Wesley Grimes, Sr.

211 Highland Ave Lenoir

Byrd, Mrs. Charles William

409 S. Orange Ave Dunn

Byrd, Mrs. William Carey

State Hospital Morganton

Byrnes, Mrs. Thomas Henderson

919 Mt. Vernon Ave Charlotte

Byrum, Mrs. Clifford Conwell

2616 Wells Ave Raleigh

Caddell, Mrs. H. Morris

Pinehurst-Pinebluff Rd Aberdeen

Cain, Mrs. Frank Coral, Jr., Pinola Ave., Gastonia
Calder, Mrs. Duncan Graham, Jr.

42 N. Union St Concord

Caldwell, Mrs. Eston Robert, Jr.

116 N. Race St Statesville

Caldwell, Mrs. Jesse Burgoyne

1307 Park Lane Gastonia

Caldwell, Mrs. Lawrence McClure

406 S. College Ave Newton

Caldwell, Mrs. Robert M.

224 S. Main St Mt. Airy

Caldwell, Mrs. Robert Sims

520 2nd St., N. W Hickory

Callaway, Mrs. Jasper Lamar

828 Anderson St Durham

IIS

NORTH CAROLINA MEDICAL JOURNAL

September, I960

Camblos, Mrs. Joshua Fry Bullitt

17 Forest Rd Asheville

Cameron, Mrs. George

307 Westview Drive Fayetteville

Cameron, Mrs. Joseph Harold

1217 Crescent Ave Gastonia

Camp, Mi . Edward Hays Waynesville

Campbell, I " s. Frank Highsmith

320 Valley Rd Fayetteville

Campbell, Mrs. James Melvin

2115 Yost Avj Salisbury

Campbell, Mrs. 1 aul Curtis, Jr.

2215 Meadow \.ood Rd - Fayetteville

Carpenter, Mrs. Coy Cornelius

Route 1, Bethabara Road Winston-Salem

Carpenter, Mrs. Harry M.

713 Austin Lane Winston-Salem

Carr, Mrs. Chalmers Rankin

1715 Queens Rd Charlotte

Carr, Mrs. Edward Sleight

3210 Forsyth Greensboro

Carrington, Mrs. George Lunsford

139 Piedmont Way Burlington

Carroll, Mrs. Charles Fisher

263 Grandview Dr Concord

Carroll, Mrs. Fountain Williams Hookerton

Carroll, Mrs. Francis Murray Chadbourn

Carter, Mrs. Francis Bayard

2111 Myrtle Dr Durham

Carter, Mrs. Needham Battle

226 Timberlane Road Rocky Mount

Carter, Mrs. Warren Dallas Wadesboro

Carver, Mrs. Gordon Malone, Jr.

2214 Cranford Rd Durham

Casstevens, Mrs. John Claude

130 Pine Valley CI Winston-Salem

Gates, Mrs. Banks Raleigh, Jr.

2833 Sunset Dr Charlotte

Cathell, Mrs. James L., State Hospital Butner

Caughran, Mrs. John H.

4400 Halsteaci Dr Charlotte

Causey, Mrs. Andrew Jackson

210 "Valley Stream Rd. Statesville

Caveness, Mrs. Zebulon Marvin

1804 Hillsboro St Raleigh

Caviness, Mrs. Verne Strudwick

913 Vance St Raleigh

Caver, Mrs. David

2754 Robin Hood Rd Winston-Salem

Cecil, Mrs. Richard C.

2314 Gunston Court Fayetteville

Cekada, Mrs. Emil Bogomir, 915 Green St., Durham

Cernugel, Mrs. Albert Peter - Chadbourn

Chambers, Mrs. Robert Edward

313 Ruby Lane Gastonia

Chamblee, Mrs. John Sigma

607 E. Church St Nashville

Chandler, Mrs. Edgar Ted

28 7th Ave., N. E Hickory

Chandler, Mrs. Weldon Porter

Box 458 Weaverville

Chapin, Mrs. John Harmon Benson

Chapman, Mrs. Charles Granger

6134 Deveron Dr Charlotte

Chapman, Mrs. Edwin James

264 Lakeshore Dr Asheville

Chapman, Mrs. Jesse Pugh, Jr.

81 Sheridan Rd Asheville

Charlton, Mrs. John David

911 Magnolia St Greensboro

Chastain, Mrs. Loren Lee Cherryville

Cheek, Mrs. John Merritt, Jr.

1025 Sycamore St Durham

Cheek, Mrs. Kenneth Maurice

402 E. Farriss .High Point

Cherny, Mrs. Walter B.

1510 Carolina Ave Durham

Chesson, Mrs. Arthur Saunders, Jr.

310 S. Andrews Ave Goldsboro

Chiles, Mrs. Noah Hampton

1031 Wellington High Point

Citron, Mrs. David Sanford

2100 Cumberland Ave Charlotte

Clapp, Mrs. Hubert Lee

Eastwood Ave Swannanoa

Clark, Mrs. DeWitt Duncan, Lox 72"^, Clarkton

Clark, Mrs. Douglas Hendon

207 W. 26th St Lumberton

Clark, Mrs. Harold Stevens

9 Lakewood Dr. Asheville

Clark, Mrs. Henrv Toole, Jr., Box 1370, Chapel Hill
Clark, Mrs. Milton Stephen

1808 E. Walnut Goldsboro

Clark, Mrs. Patrick Francis

208 Cumberland Asheville

Clarke, Mrs. Len Gordon

606 Fieldcrest Rd. Draper

Clarke, Mrs. William Lowe, Jr.

401 7th Ave. PI., N. W Hickory

Clary, Mrs. William Thomas

507 Chancery PI Greensboro

Clay, Mrs. Thomas Barger, Jr.

300 N. Third Ave Mayodan

Clayton, Mrs. Eugene Cook

17 St. Charles PI Asheville

Cleaver, Mrs. H. DeHaven

213 Cornwallis Rd Durham

Clinton, Mrs. Roland Smith

1305 Fairfield Dr Gastonia

Clippinger, Mrs. Frank W.

2511 Pickett Rd Durham

Cloninger, Mrs. Charles Edgar Conover

Cloninger, Mrs. Giles Lathern

301 Dogwood Lane Hamlet

Cloninger, Mrs. Kenneth Lee

Westlake Hills Newton

Cloninger, Mrs. Rowell Connor

Westfield Rd Shelby

Clutts, Mrs. George Robert

227 N. Park Dr Greensboro

Cobey, Mrs. William Gray

527 Clement Ave Charlotte

Cochcroft, Mrs. Roy Leicester

217 W. Washington Ave Bessemer City

Cochran, Mrs. John L., Jr.

413 N. Elm St Asheboro

Cochrane, Mrs. Fred Richard, Jr.

1614 Maryland Ave Charlotte

Codington, Mrs. John Bonnell

2715 Columbia Ave Wilmington

Coffee, Mrs. Archie Thomas, Jr.

2717 Chilton PI Charlotte

Coffman, Mrs. Selby, Longmeadow Rd. .Greenville
Cogdell, Mrs. David Melvin

2827 Skye Dr Fayetteville

Coggeshall, Mrs. Allen Bancroft

109 Beverly PI Greensboro

Cohen, Mrs. Sanford Irwin

1527 Woodburn Rd Durham

Coker, Mrs. Robert Ervin, Jr.

810 Christopher Rd Chapel Hill

Cole, Mrs. Herman Alfonse

211 E. Blanche Clayton

Cole, Mrs. Robert Hickman

1537 Coventry Rd Charlotte

Cole, Mrs. Walter Francis

201 E. Avondale Greensboro

Coleman, Mrs. Lester Livingston

428 Sixth St., N. W Hickory

Colev, Mrs. Ehvood Brogden

602 W. 31st St Lumberton

Collett. Mrs. James Rountree

W. U^ion St Morganton

Collins, Mrs. Wan-en James, 713 Ridgeview, Shelby

September, 1960

ROSTER OF MEMBERS

419

Combs, Mrs. Fielding

438 Carolina Circle Winston-Salem

Combs, Mrs. Joseph John

2125 White Oak Rd Raleigh

Compton, Mrs. John Wallace

608 S. Oleander Ave Goldsboro

Cook, Mrs. Henry Lilly, Jr.

Irving Park Manor Greensboro

Cook, Mrs. Joseph Lindsay

Nutbush Rd Greensboro

Cook, Mrs. William Eugene

115 S. Churchill Dr Fayetteville

Cooke, Mrs. Grady Carlyle

Bonham Heights Morehead City

Cooke, Mrs. Hershall Marcus

Route 1, Box 227 Boone

Cooke, Mrs. Quinton Edwin

212 E. High St Murfreesboro

Cooke, Mrs. Ralph M., E. Main Sc Eikin

Cooley, Mrs. Samuel Studdiford

221 New Bern Ave Black Mountain

Cooper, Mrs. Albert Derwin

1006 Dacian Ave Durham

Cooper, Mrs. Frank Benton

1129 Emerald St Salisbsury

Cooper, Mrs. George Marion

411 Marlowe Road Raleigh

Copnedge, Mrs. Thomas Oliver, Jr.

112 Cedar Lane, Route 2 Charlotte

Coppridge, Mrs. James Alston

2020 Wilson St Durham

Cop;>ridge, Mrs. William Maurice

1024 W. Forest Hills Blvd Durham

Corbett, Mrs. Clarence Lee

W. Cumberland St Dunn

Corbett, Mrs. James Patrick Swansboro

C-orbin, Mrs. George Wesley, Jr Rolesville

Cordell, Mrs. Alfred Robert

963 Kenleigh Circle Winston-Salem

Cornwell, Mrs. Abner Milton

825 S. Aspen St Lincolnton

Corpening, Mrs. Joseph Durham

228 Rutherford St Salisbury

Corpening, Mrs. Oscar J Granite Falls

Corpening, Mrs. William Nye Granite Falls

Correll, Mrs. Earl Eugene

1603 Eastwood Drive Kannapolis

Cosgrove, Mrs. Kenneth Edward

306 Laurel Dr .Hendersonville

Costner, Mrs. Walter Vance

501 N. Cedar St Lincolnton

Coughlin, Mrs. Joyce Desmond

150 Cherokee Rd Asheville

Council, Mrs. Albert Barbee

Von Ruck St Spray

Couturier, Mrs. Maurice George, Sr Reidsville

Covington, Mrs. Furman Payne

216 Forsyth St. Thomasville

Covington, Mrs. James Madison, Sr Wadesboro

Covington, Mrs. James Madison, Jr.

Morven Road — ~ Wadesboro

Covington, Mrs. John Malloy Clayton

324 Jackson St Roanoke Rapids

Covington, Mrs. Mai-tin Cade

2107 Woodland Ave Sanford

Cox, Mrs. Alexander McNeil

325 Market St Madison

Cox, Mrs. Samuel Clements

8 E. Bayshore Blvd Jacksonville

Cox, Mrs. William Foscue

2722 Reynolds Rd Winston-Salem

Cozart, Mrs. Benjamin Franklin

Box 1289 Reidsville

Cozart, Mrs. Wiley Holt

Box 327 -Fuquav Springs

Cozart, Mrs. Wiley S.

333 S. Main Fuquay Springs

Craddock, Mrs. John Goodwin

1501 Anderson St Wilson

Craig, Mrs. Robert Lawrence

382 Montford Ave Asheville

Craig, Mrs. William Kenneth Enfield

Crandell, Mrs. Daniel LeRoy

755 Pine Valley Rd Winston-Salem

Crane, Mrs. George Levering

2028 Pershing St Durham

Crane, Mrs. George William, Jr.

2618 Augusta Dr Durham

Craven, Mrs. Frederick Thorns

29 Ravine Ave Concord

Crawford, Mr?. Robert Hope

216 S. Ridgecrest Ave Rutherfordton

Crawford, Mrs. Robert Orr, Jr.

P. O. Eox 483 Claremont

Crawford, Mrs. William Jennings

1500 E. Ash St Goldsboro

Crawley, Mis. Sam Jones, Jr Boiling Springs

Crer.'.ick. .lis. Robert Nowell

1200 Andsrson St Durham

Creech. Mrs. Lemuel Underwood

220 Edgedale Dr High Point

Creed, Mrs. George Otis, Johns Rd Laurinburg

Cre:cenzo, Mrs. Victor M.

Belmcnt Drive Reidsville

Crisp, Mrs. Sellers Mark

1201 E. 5th St ..-_- Greenville

Crissman, Mrs. Clinton S., Chapel 1-j.ill Rd., Graham
Cronland, Mrs. Murphy Allen

226 W. Pine Lincolnton

Croom, Mrs. Arthur Bascom

1102 Greenwav Dr High Point

Croom, Mrs. Robert DeVane, Jr Maxton

Crosby, Mrs. James Foster

5015 Park Road Charlotte

Crosby, Mrs. Lewis Pearce Reidsville

Cross, Mrs. Almon Rufus

414 Hillcrest Dr .High Point

Cross, Mrs. Robert Vandervoort

920 Fairway Dr High Point

Crouch, Mrs. Auley McRae, Sr.

520 Dock St Wilmington

Crouch, Mrs. Auley McRae, Jr.

1419 S. Live Oak Parkway Wilmington

Crouch, Mrs. Walter Lee

1211 S. Live Oak Parkway Wilmington

Crow, Mrs. Samuel Leslie

12 N. Kensington Rd. Asheville

Crowell, Mrs. James Allen

1529 E. Morehead St Charlotte

Crowell, Mrs. Lester Avant, Jr.

413 S. Aspen St Lincolnton

Crumpler, Mrs. James Fulton

1409 West Haven Blvd Rocky Mount

Crumpler, Mrs. Paul

401 Lafayette St Clinton

Crumpler, Mrs. Warren Harding

N. Johnson St Mt. Olive

Crutchfield, Mrs. Andrew Jackson

300 Plymouth Ave Winston-Salem

Cubberlev, Mrs. Charles Lamb, Jr.

505 Lafayette Dr Wilson

Cuibreth, Mrs. George Gordon

2228 Queens Rd., E Charlotte

Cumen, Mrs. Edward C, Jr.

322 W. University Dr Chapel Hill

Currie, Mrs. Daniel Smith, Jr.

302 Churchill Dr Fayetteville

Currie, Mrs. Daniel Smith, Sr Parkton

Currv, Mrs. Clayton Smith

2701 Bucknell Ave Charlotte

Curtis, Mrs. Thomas E.

Sherwood Forest Chapel Hill

Cutchin, Mrs. Joseph Henry, Sr.

Box 202 Whitakers

Cutchin, Mrs. Joseph Henry, Jr Sherrill's Ford

420

NORTH CAROLINA MEDICAL JOURNAL

September, 1960

Cutri, Mrs. Joseph John

Graylyn Court Winston-Salem

Dale, Mrs. Frederick Payne

503 Rhodes Ave Kinston

Dalton, Mrs. Horace Milton

1705 Cambridge Dr Kinston

Daly, Mrs. Rosvvell Bernard Waxhaw

Dameron, Mrs. Thomas Barker, Jr.

2710 E. Rothgeb Dr. .. Raleigh

Daniel, Mrs. Crowell Turner, Jr.

330 Pinecrest Dr Fayetteville

Daniel, Mrs. Thomas Brantley

3231 Sussex Rd Raleigh

Daniel, Mrs. Thomas Manning

524 S. Fourth St Smithfield

Daniel, Mrs. Walter Eugene

2115 Roswell Ave Charlotte

Daniels, Mrs. Robert Edward

23 Vance Crescent West Asheville

Darden, Mrs. James Lee, Jr.

1000 Pembroke Ave Ahoskie

Daughtridge, Mrs. Arthur Lee

501 Shady Circle Dr Rocky Mount

Daughtridge, Mrs. Griffin Caswell

526 Marigold St Rocky Mount

Davant, Mrs. Charles, Chestnut Dr., Blowing Rock
Davenport, Mrs. Carlton Alderman

207 Front St Hertford

Davenport, Mrs. Clifton Lake Waccamaw

Davidson, Mrs. Alan, Morehead Rd New Bern

Davidson, Mrs. James Hubert

2200 Sprunt St Durham

Davis, Mrs. Courtland Harwell, Jr.

841 Westover Ave Winston-Salem

Davis, Mrs. David A., Kings Mill Rd., Chapel Hill

Davis, Mrs. Jack Beason Waynesville

Davis, Mrs. James Evans, 7 Beverly Dr., Durham

Davis, Mrs. James Matheson Wadesboro

Davis, Mrs. John Woodrow

Route 5, Box 509 Hickory

Davis, Mrs. Joseph Franklin

Box 6291 Summit Station Greensboro

Davis, Mrs. Junius Weeks, Jr.

Trent Shores New Bern

Davis, Mrs. Philip Bibb

807 Florham Ave High Point

Davis, Mrs. Richard Boyd

122 S. Green Greensboro

Davis, Mrs. Rufus Jackson, Lakewood, Cramerton
Davis, Mrs. Wayne Edward

321 Avalon Road ..Winston-Salem

Davis, Mrs. William Hersey, Jr.

723 N. Stratford Rd Winston-Salem

Davison, Mrs. Wilburt Cornell

3004 Norwich Way Durham

Dawson, Mrs. James Nelson Acme-Delco

Deaton, Mrs. Paul McNeely

581 Greenway Dr Statesville

Deaton, Mrs. William Ralph, Jr.

101 Elgin Place Greensboro

DeCamp, Mrs. Allen Ledyard

1830 Cassamia PI Charlotte

Deeds, Mrs. Charles Ross

Haywood Rd Hendersonville

DeWolfe, Mrs. Phillip William,

Box 106 Leaksville

Dick, Mrs. Frederick William

354 Bost St Statesville

Dick, Mrs. Macdonald

3005 Norwich, Hope Valley Durham

Dickeison, Mrs. Andi-ew Jackson Waynesville

Dickie, Mrs. James William

3003 Wayne Dr Wilmington

Dickson, Mrs. Brice Templeton, Jr.

1436 Fern Forest Drive Gastonia

Dickson, Mrs. Malcolm Shields

1903 Woodland Ave Burlington

Dillard, Mrs. Sam Booker

1309 Biltmore Dr Charlotte

Dixon, Mrs. George Grady

503 Snow Hill St Avden

Dixon, Mrs. Philip Lafayette, Jr.

1 Bayshore Blvd., E Jacksonville

Dobson, Mrs. Richard L.

14 Brandon Rd. Chapel Hill

Doffermyre, Mrs. Luther Randolph

W. Harnett St Dunn

Donald, Mrs. William Blan.on, Jr.

603 Rockspring Rd .High Point

Donner, Mrs. Paul Gartrell

2201 Old Sardis Rd ..Charlotte

Dorenbusch, Mrs. Alfred A.

2734 Hampton Ave Charlotte

Dorman, Mrs. Bruce Hugh

Greenville Sound Wilmington

Dorsett, Mrs. John Dewev

143 Hamilton Rd .. Chapel Hill

Douglas, Mrs. John Munroe

400 Fferneliff Charlotte

Dovenmuehle, Mrs. Robert Henry

3527 Hamstead Court Durham

Downs, Mrs. Kenneth Ray

4112 Barmettler Dr Charlotte

Downs, Mrs. Posey Edgar, Jr.

101 Placid Place Charlotte

Doyle, Mrs. Owen William

906 Dover Rd Greensboro

Drake, Mrs. Benjamin Michael

1310 Jackson Rd Gastonia

Drake, Mrs. David Ewing

2616 Bennington Rd Fayetteville

Drummond, Mrs. Charles Stitl

2928 Windsor Rd Winston-Salem

Duckett, Mrs. Charles Howard Canton

Duckett, Mrs. Virgil Howard Canton

Dudley, Mrs. Council C, Jr Jonesville

Dugger, Mrs. Gordon S.

UNC Medical School Chapel Hill

Dula, Mrs. Frederick Mast

214 Hibriten St Lenoir

Dunn, Mrs. Richard Barry

1014 N. Elm St Greensboro

Dunning, Mrs. Everett Jackson

2501 Danbury St Charlotte

Durham, Mrs. Carey Winston

209 W. Ridgeway Dr Greensboro

Dyer, Mrs. David Patterson Waynesville

Eagle, Mrs. James Carr, 418 Carolina Ave., Spencer
Eagle, Mrs. Watt Weems

804 Anderson St Durham

Eagles, Mrs. Charles Sidney Saratoga

Early, Mrs. Ira Gordon

2510 Bitting Rd Winston-Salem

Easom, Mrs. Herman Franklin

508 Mt. Vernon Dr Wilson

Eastwood, Mrs. Frederick Thomas

2708 Lakeview Dr Raleigh

Eaves, Mrs. Rupert Spencer

611 N. Washington Rutherfordton

Eckbert, Mrs. William Fox, Southwood ...Gastonia

Eckerson, Mrs. Charles Troy

Eddinger, Mrs. Charles Frederick, Box 45, Spencer
Eddins, Mrs. George Edgar, Jr.

Norwood Rd Albemarle

Edgerton, Mrs. Glenn Soulders

325 Cherokee PI Charlotte

Edwards, Mrs. Charles Daniel

418 E. 12th St Washington

Edwards, Mrs. Vertie D Stokesdale

Eg-erton, Mrs. Courtney David

2528 York Rd Raleigh

Elesha, Mrs. William

3040 Briarcliffe Rd Winston-Salem

Elfmon, Mrs. Samuel Leon

117 Stedman St Fayetteville

September, 1960

ROSTER OF MEMBERS

421

Ellington, Mrs. Amzi Jefferson, Jr.

419 Fountain Place Burlington

Elliott, Mrs. Avon Hall

607 Colonial Drive Wilmington

Elliott, Mrs. John Palmer, Greenway Drive, Spray
Elliott, Mrs. Joseph Alexander, Sr.

2700 Sherwood Ave Charlotte

Elliott, Mrs. Joseph Alexander, Jr.

2224 Sanford Lane Charlotte

Elliott, Mrs. William McBrayer

West View Forest City

Epple, Mrs. Kenneth H.

1518 Liberty Drive .Greensboro

Erb, Mrs. Norris Scribner, 8 Oak Rd. ...Salisbury
Erdman, Mrs. Lawrence Huntington

P. 0. Box 283 Bridgeton

Ernst, Mrs. Henry Edwin

97 Ingleside Dr Concord

Ervin, Mrs. John Witherspoon

State Hospital Morganton

Erwin, Mrs. Evan Alexander, Jr.

S. Main Laurinburg

Espey, Mrs. Dan, Jr.

454 5th St., S. E Hickory

Estes, Mrs. Edward Harvey, Jr.

3542 Hamstead Court Durham

Etherington, Mrs. John Lawrence

1703 Evergreen Ave Goldsboro

Fagan, Mrs. Harry, Jr.

2508 Oxford Rd Raleigh

Faison, Mrs. Elias Sampson

1825 Providence Rd. Charlotte

Fales, Mrs. Robert Martin

153 Renovah Circle Wilmington

Falls, Mrs. Fred, 855 W. Marion St Shelby

Falvo ,Mrs. Samuel Catanzaro

716 Maybank Drive Hendersonville

Farley, Mrs. William Winfree

2625 Dover Rd Raleigh

Farmei-, Mrs. Thomas Wholsen

Mason Farm Rd Chapel Hill

Farmer, Mrs. William Anderson

2841 Skye Dr Fayetteville

Farmer, Mrs. William Dempsey

1011 Country Club Dr Greensboro

Farmer, Mrs. Woodard Eason

27 Park Road Asheville

Faulk, Mrs. James Grady

1208 E. Franklin Monroe

Feezor, Mrs. Charles Noel

6 Pine Tree Rd Salisbury

Feldman, Mrs. Leon Henry

6 N. Kensington Rd Asheville

Felton, Mrs. Robert Lee, Jr., Box 176, Carthage
Felts, Mrs. John Harvey, Jr.

245 New Drive Winston-Salem

Fender, Mrs. James Earle Waynesville

Ferguson, Mrs. George Burton

3938 Dover Rd., Hope Valley Durham

Ferrell, Mrs. John Atkinson

Apt. 8-B, Carolina Hotel Raleigh

Fesperman, Mrs. Joseph Claude

West College St Stanley

Fetter, Mrs. Bernard Frank

Summerset Drive Durham

Feuer, Mrs. Abe Lawrence

1006 Fairfield Dr Gastonia

Fewell, Mrs. Richard Alexander

506 Hillcrest Rd Burlington

Ficklin, Mrs. Conway

908 Live Oak Parkway ..Wilmington

Field, Mrs. Bob Lewis, Box 557 Salisbury

Fields, Mrs. Leonard Earl

Box 788, Hidden Hills . Chapel Hill

Fike, Mrs. Ralph Llewellyn

901 Raleigh Rd Wilson

Fincher, Mrs. Robert Charles, Jr.

107 Spencer St High Point

Finley, Mrs. Charles Francis

2323 Morganton Rd Fayetteville

Fish, Mrs. Harry Gustav, Jr.

1116 Long Ave Rocky Mount

Fisher, Mrs. George Walton, Jr.

2612 Edgewater Dr Fayetteville

Fitz, Mrs. Thomas Edmunds

423 10th St. Dr Hickory

Fitzgerald, Mrs. Charles Edmund

415 E. Wilson St Farmville

Fitzgerald, Mrs. John Dean

210 Crestwood Dr Roxboro

Fitzgerald, Mrs. John Hill, Jr.

217 Buff St Lincolnton

Fitzgerald, Mrs. Robert Greeson, Jr.

Box 256 Roxboro

Fleetwood, Mrs. Joseph Anderton, Jr Conway

Fleetwood, Mrs. Joseph Anderton, Sr Conway

Fleishman, Mrs. Malcolm

130 Herndon St Fayetteville

Fleming, Mrs. Lawrence Edwin

1116 Providence Rd Charlotte

Fleming, Mrs. Major Ivy

104 S. Franklin St Rocky Mount

Fleming, Mrs. Ralph Gibson

23 Beverly Dr Durham

Fleming, Mrs. Samuel Wallace Elm City

Flippin, Mrs. James Meigs Pilot Mountain

Flowe, Mrs. Benjamin Hugh, 804 Wilmar, Concord
Floyd, Mrs. Anderson Gayle

N. Thompson St Whiteville

Floyd, Mrs. Hal Stanfield

Lake View Rd Fairmont

Floyd, Mrs. Walter, 2011 Woodrow St Durham

Floyd, Mrs. William Russell

Mt. Pleasant Highway Concord

Flythe, Mrs. William Henry

809 Hillcrest Dr High Point

Fogleman, Mrs. Ross Lee, Jr.

904 W. Highland Ave Kinston

Folio, Mrs. Paige Bill, 1709 Efland Dr., Greensboro
Fondren, Mrs. Frank

302 Jackson St Roanoke Rapids

Forbes, Mrs. Gus Evans, Park Circle, Laurinburg
Forbes, Mrs. Thomas Earl

Country Club Drive Reidsville

Forbus, Mrs. Wiley Davis, 3309 Devon Rd., Durham
Forrest, Mrs. William W.

1001 Montpelier Dr Greensboro

Forsyth, Mrs. Harry Francis

434 Westview Dr Winston-Salem

Fortescue, Mrs. William Nicholas

Kanuga Rd Hendersonville

Fortney, Mrs. Austin Powell Jamestown

Fortune, Mrs. Benjamin Fletcher

906 Cornwallis Dr Greensboro

Foster, Mrs. John W.

294 W. End Blvd. Winston-Salem

Foster, Mrs. Malcolm Tennyson

114 Stedman St Fayetteville

Foushee, Mrs. J. Henry Smith, Jr.

748 Barnesdale Rd Winston-Salem

Fowler, Mrs. Henry Jackson

Box 403 Walnut Cove

Fowler, Mrs. John A.

1409 Woodbuxn Rd Durham

Fox, Mrs. Dennis Bryan, McGill Dr., Albemarle
Fox, Mrs. Norman Albright, Jr.

Friendly Rd Guilford College

Fox, Mrs. Norman Albright, Sr.

Friendly Rd Guilford College

Fox, Mrs. Powell Graham

2910 Fairview Rd Raleigh

Fox, Mrs. Powell Graham, Jr.

3013 Medlin Drive Raleigh

Fox, Mrs. Robert Eugene

1011 E. Main St Albemarle

42:2

NORTH CAROLINA MEDICAL JOURNAL

September, 1960

Fox, Mrs. William Morgan

435 Charlotte Dr Fayetteville

Fraasa, Mr.--. Rohei i ( <niia<i

122(5 Tarrington Dr Charlotte

Franklin, Mrs. Ernest Washington

11-11 Linganore PI. Charlotte

Franklin, Mrs. Robert Benjamin Clinton

227 Rockford St Mt. Airy

Frazier, Mrs. Claude Albee

14 Buena Vista Rd Asheville

Frazier, Mrs. John Wesley. Jr.

Pine Tree Rd Salisbury

Freedman, Mrs. Arthur

1305 Hobbs Rd Greensboro

Freeman, Mrs. Percy Lee

1018 Paramount Circle Gastonia

Freeman, Mrs. Roy Oscar JclT

Freeman, Mrs. William Han. i n

(ill Yadkin St Albemarle

Freeman, Mrs. William Talmadge

311 Vanderbilt Rd Asheville

Fritz, Mrs. Olin Gradv Walkertown

Fritz, Mrs. William Abel

636 Third St., N. E. Hickory

Frizelle. Mrs. Mark Twain, 507 S. Lee St. Ayden
Frohbose, Mrs. William Joseph

1524 Beal St Rocky Mount

Frye, Mrs. Glenn Raymer

539 N. Center St Hickory

Fulcher, Mrs. Luther Beaufort

Fuller, Mrs. David H.

State Hospital Raleigh

Fuller, Mrs. Henry Fleming

1302 Walker Dr Kinston

Fulp, Mrs. James Francis

Bryan Street - Stoneyville

Futch, Mrs. William Alexander

217 Brentwood Ave Jacksonville

Gadd, Mrs. Duwayne Douglas

Linden Road Pinehurst

Gainey, Mrs. John White, Jr Morehead City

Gallant, Mrs. Robert Miller

809 Central Ave Charlotte

Galloway. Airs. James Hervey

200 Shepherd St Raleigh

Galusha, Mrs. Bryant Leroy

1419 Ferncliff Charlotte

Gamble, Mrs. John Reeves, Jr.

Box 270 Lincolnton

Gambrel, Mrs. Ralph

546 Wilkesboro St Mocksville

Garber, Mrs. Edgar Clyde, Jr.

1810 Lakeshore Dr Fayetteville

Garrard, Mis. Robert Lemley

101 N. Park Dr Greensboro

Garrenton, Mrs. Connell George Bethel

Garrett, Mrs. John Bostian Walkertown

Garrett, Mrs. Norman Hessen, Jr.

3932 Madison Ave Greensboro

Garrison, Mrs. Paul Leslie

1837 Buena Vista Winston-Salem

Garrison, Mrs. Ralph Bernard, Cheraw Rd., Hamlet
Garrison, Mrs. Robeit Lee

2118 Beverly Dr Charlotte

Garvey, Mrs. Fred Kesler

J.40 Fairfax Dr. Winston-Salem

Garvey, Mrs. Robert Roby

Boone Highway Blowing Rock

Gaskin Mrs. Ernest Reed

1000 Nottingham Dr Charlotte

Gaskin, Mrs. Lewis Reed

274 N. Fourth St Albemarle

Gaskin, Dr. Madge Baker

265 N. Third St Albemarle

Gaul, Mrs. John Stuart, Jr.

2010 Sharon Lane Charlotte

Gaul, Mrs. John Stuart, Sr.

2119 Norton Rd Charlotte

Gay, Mrs. Charles Houston

143 Huntley PI Charlotte

Geddie, Mrs. Kenneth Baxter

1121 Rotary Dr High Point

Gee, Airs. William N., Jr.

1001 S. Madison loldsboro

Gentry. Mrs. George Wesley Box 14t> Roxboro

Gentry, Mrs. William Harold

N. C. Sanatorium McCain

Georgiade, Mrs. Nicholas G.

2523 Wrightwood Ave Durham

Germouth, Mrs. Frederick Geo

2100 Sherw 1 Ave Charlotte

Gibbon, Mrs. James Wilson

720 Bromley Rd Charlotte

Gibbons, Mrs. Julius Joyce, Jr.

215 Highland Ave Lenoir

Gibbs, Mrs. Norfleet M.

209 Johnson St New Bern

Gibbs, Mrs. Stuart Wynn

Armstrong Park Circle Gastonia

Gibson, Mrs. Milton Reynolds

105 Chamberlain St Raleigh

Gibson, Mrs. Thomas G., Jr. .... liib ■ n

Gilbert, Mrs. George Gaylord

1 St. Dunstans Rd Asheville

Gill, Mrs. Joseph Armstrong

803 River Rd ab i City

Gilliam, Mrs. James Sylvester, Jr.

607 W. Lexington Ave High Point

Gilmore, Mrs. Clyde Manly

108 E. Avondale Greensboro

Gilmour, Mrs. Monroe Taylor

734 Granville Rd Charlotte

Givens, Mrs. George H., Jr. Taylorsville

Glasgow, Mrs. Douglas McKay

2022 Glendale Rd Charlotte

Glasson, Mrs. John, 615 Swift Ave Durham

Glenn, Mrs. Channing, Box 335 Elizabethtown

Glenn, Mrs. Charles Foster

405 Ridgecrest Ave Rutherfordton

Glenn, Mrs. Henry Franklin, Jr.

319 S. Oakland Ave Gastonia

Glenn, Mrs. John C, Jr.

200 Hempstead PI Charlotte

Glenn, Mrs. Richard Reece

2507 Miller Park CI Winston-Salem

Gobble. Mrs. Fleetus Lee, Jr.

925 S. Hawthorne Rd Winston-Salem

Godwin, Mrs. Harold Lacy

1811 Lakeshore Dr Fayetteville

Gold, Mrs. Ben Miller, Jr.

Country Club Dr Rocky Mount

Goldner, Mrs. J. Leonard

602 E. Forest Hills Blvd Durham

Goley, Mrs. Willard Coe, 217 N. Main St Graham

Goode, Mrs. Thomas Vance, III

326 Summit Ave Statesville

Gooding, Mrs. Guy U Kenansville

Goodman, Mrs. Benjamin Warren

226 Fifth St., S. E Hickory

Goodwin, Mrs. Cleon Walton

1107 W. Nash St Wilson

Goodwin, Mrs. Oscar Sexton. Raleigh Rd Apex

Googe, Mrs. James Turner

335 Grand Boulevard Boone

Gore, Mrs. John Pratt

957 Lambeth Circle Durham

Goswick, Mrs. Claude Benjamin

1747 Clairmont Drive Hendersonville

Goswick. Mrs. Harry Wilson. Jr.

280 Canterbury Trail Winston-Salem

Gradis, Mrs. Howard Henry-
Forest Hill Drive Greenville

Grady, Mrs. Edward Stephen, Box 447 ....Smithfield
Grady, Mrs. Franklin McLean

Madam Moore's Lane New Bern

September, 1960

ROSTER OP MEMBERS

423

Grady, Mrs. Leland Vaine

1527 W. Nash St Wilson

Graham, Mrs. Charles Pattison

123 Forest Hills Dr Wilmington

Graham, Mrs. John Borden

Roosevelt Rd Chapel Hill

Graham, Mrs. Walter Raleigh

741 Hempstead PI Charlotte

Graham, Mrs. William Alexander

2247 Cranford Rd Durham

Gray, Mrs. Cyrus Leighton

912 Rotary Dr High Point

Green, Mrs. Harold David

1172 Hawthorne Rd Winston-Salem

Green, Mrs. Philip Palmer

435 E. Indiana Ave Southern Pines

Greene, Mrs. Phares Yates

1004 E. Willowbrook Dr Burlington

Greene, Mrs. William Alexander

500 Pinkney St Whiteville

Greenwood, Mrs. James Brooks, Jr.

2319 Providence Rd Charlotte

Gregg, Mrs. Robert A.

3411 Cloverdale Dr Greensboro

Gregory, Mrs. John Eugene

521 Confederate Ave Salisbury

Gregory, Mrs. R. D., Jr.

105 Kimberly Knoll Asheville

Gregory, Mi's. William Lvon

120 Easton Burton Hill .Lowell

Gridley, Mrs. Timothy H.

820 Carolina Ave Fayetteville

Grier, Mrs. Charles Talmadge, Box 475 ...Carthage
Grier, Mrs. John Calvin, Jr.

Midland Road Pinehurst

Griffin, Mrs. Harold Walker

537 N. Center St Hickory

Griffin, Mrs. Mark Alexander, Jr.

11 Forrest Rd Asheville

Griffin, Mrs. Robert Ashlev

11 Hilltop Rd Asheville

Griffin, Mrs. Thomas Ray, Box 328 Troutman

Griffin, Mrs. William Rav, Jr.

30 Hilltop Rd Asheville

Griffin, Mrs. William Ray, Sr.

8 Edwin Place Asheville

Griffis, Mrs. John William, Box 191 Denton

Griggs, Mrs. Bovce Powell

811 N. Oak St Lincolnton

Griggs, Mrs. Willard Wilson, Box 217 Norwood

Grim, Mrs. Kenneth Boyd, 1421 Broad St. Durham
Grimmett, Mrs. Matthew Hill

107 Country Club Dr Concord

Groome, Mrs. James Gordon

203 Edgedale Dr High Point

Gross, Mrs. Francis Warren

408 W. Lexington Ave ...High Point

Grove, Mrs. Raymond Fisk

1400 Live Oak Pkwy Wilmington

Groves, Mrs. Robert Burwell, Sr Lowell

Groves, Mrs. Robert Burwell, Jr.

2565 Pinewood Drive Gastonia

Gulley, Mrs. Marcus Marcellus

Faculty Apartments Winston-Salem

Gunn, Mrs. Charles Groshon

972 Kenleigh Circle Winston-Salem

Gunter, Mrs. June U.

1411 N. Mangum St. Durham

Gwynn, Mrs. Houston Lafayette, Box 6, Yanceyville

Haar, Mrs. Frederick Behrend

608 E. 9th St Greenville

Hackney, Mrs. Ben H Lucama

Hadley, Mrs. Herbert Wood

2607 S. Dickinson Ave Greenville

Hagaman, Mrs. John Bartlett, Jr.

304 North St Boone

Hagaman, Mrs. Len Doughton

101 Cherry Dr _ Boone

Haines, Mrs. Hilton Drummond

700 E. Washington St Rockingham

Haines, Mrs. Innes Correll

818 Anarine Rd Fayetteville

Hairfield, Mrs. Beverly Dew

415 W. Union St Morganton

Hairfield, Mrs. Theodore Vincent

404 Westview St Lenoir

Hall, Mrs. James Brownlee Matthews

Hall, Mrs. John Moir, W. Main St Elkin

Hall, Mrs. Joseph Cullen

839 Fairmont Ave Salisbury

Hall, Mrs. William Bruce, Jr.

543 Vista Dr Fayetteville

Hall, Mrs. William Dewey

510 Washington St Roanoke Rapids

Hall, Mrs. William Hugh

3635 Barclay Downs Dr Charlotte

Ham, Mrs. Clem, West Blvd Laurinburg

Ham, Mrs. George Calverno

519 Dogwood Dr Chapel Hill

Hambrick, Mrs. Robert Theodore

529 Sixth St., N. W Hickory

Hambright, Mrs. Rufus Roberts

1809 Elkhart Dr Greensboro

Hamer, Mrs. Alfred Wilson

112 Pearson Dr Morganton

Hamer, Mrs. Douglas, Jr.

205 Norwood St Lenoir

Hamer, Mrs. Eugene Floyd, P. O. Box 476 ....Monroe
Hamilton, Mrs. Alfred Thomason

1422 Canterbury Rd Raleigh

Hamilton, Mrs. Frank Hutchinson, Jr.

2815 Marlowe Dr. ..._ _ Charlotte

Hamilton, Mrs. John Homer

2124 Cowper Dr Raleigh

Hamilton, Mrs. Joseph Franklin, Jr.

Albemarle Circle Asheville

Hammond, Mrs. Alfred Franklin, Jr.

1514 Neuse Blvd New Bern

Hamrick, Mrs. John Carl, 1002 Kings Rd Shelby

Hamrick, Mrs. Ladd Watts, Jr.

103 Country Club Dr Concord

Hamrick, Mrs. Robert Arnold

927 Hill St Rocky Mount

Hand, Mrs. Edgar Hall Pineville

Hand, Mrs. LeRoy Corbett, Jr Gatesville

Hanes, Mrs. Gideon Isaac, Jr.

836 Wellington Road Winston-Salem

Happer, Mrs. William

205 Woodsway Lane Lenoir

Harbison, Mrs. John William

911 N. Washington St Shelby

Hardaway, Mrs. John Stegar

434 Oakwood Dr Statesville

Hardin, Mrs. Eugene Ramsey

1103 N. Elm St Lumberton

Hardin, Mrs. Richard Henry

S. Granville St Edenton

Hardin, Mrs. Ronda Horton

Wilkesboro Rd Boone

Hardison, Mrs. Lewis Benjamin

113 Star Hill Rd _ Fayetteville

Hardman, Mrs. Edward Francis

Route 2, Huntington Park Charlotte

Hare, Mrs. Roy Allen, 1023 Sycamore St Durham

Harer, Mrs. Adolph Eugene

1609 Canterbury Rd Raleigh

Hargrove, Mrs. Eugene Alexander

713 Greenwood Rd Chapel Hill

Harloe, Mrs. John Pincknev

669 Hempstead PI Charlotte

Harmon, Mrs. Raymond Harris

Highland Dr Boone

424

NORTH CAROLINA MEDICAL JOURNAL

September, 1060

Harper, Mrs. Matt C, Jr.

Caswell Training School Kinston

Harper, Mrs. Robert N.

3322 Ocatea Drive Raleigh

Harrell, Mrs. William Fletcher, Jr.

Brother's Dr Elizabeth City

Harrill, Mrs. Henry Clay

100 Elmwood Terrace Greensboro

Harrill, Mrs. James Albert

2860 Reynolds Rd Winston-Salem

Harrington, Mrs. Lee I., Jr.

2423 Fairway Dr Winston-Salem

Harris, Mrs. Carlton McKenzie

204 Meadowbrook Terr Greensboro

Harris, Mrs. Charles Isaac, Jr.

500 School Drive Williamston

Harris, Mrs. Charles Theodore, Jr.

425 Roberts Rd Salisbury-
Harris, Mrs. Isaac Emerson, Jr.

3900 Dover Rd., Hope Valley Durham

Harris, Mrs. Julian L.

1660 Mansfield Rd Winston-Salem

Harris, Mrs. Loftin Howell

417 East St Albemarle

Harris, Mrs. Tyndall Peacock

410 Westwood Dr Chapel Hill

Harry, Mrs. John McKamie

832 W. Rowan St Fayetteville

Hart, Mrs. Julian Deryl

Duke University Rd. Durham

Hart, Mrs. Lillard Franklin, 236 E. Olive ... Apex
Hart, Mrs. Oliver James

1930 Georgia Ave Winston-Salem

Hart, Mrs. Verling Kersey

106 W. 7th St Charlotte

Hartman, Mrs. Bernhard Henry

12 Cambridge Rd Asheville

Hartness, Mrs. William Rufus, Jr.

615 Carr St Sanford

Hatcher, Mrs. Samuel W Morehead City

Hawes, Mrs. Cecil Jennings

2101 Wendover Rd Charlotte

Hawes, Mrs. George Aubrey

1862 Queens Rd. W Charlotte

Hawkins, Mrs. Barry Fugh

330 Sunset Dr Concord

Hawkins, Mrs. Hal Burgess Moravian Falls

Hawkins, Mrs. James Hubert Alamance

Hayes, Mrs. James Willard

Lake View Rd Fairmont

Hayes, Mrs. William Clayton

Woodland Blvd Wilkesboro

Hayman, Mrs. Louis DeMaro, Jr.

203 W. Bayshore Blvd Jacksonville

Haywood, Mrs. Hubert Benbury, Jr.

2718 Gloucester Rd Raleigh

Heafner, Mrs. Bob O Stony Point

Hedgepeth, Mrs. Emmett Martin

Crestwood Dr Roxboro

Hedgpeth, Mrs. Edward McGowan

Rt. 3, Box 87 Chapel Hill

Hedgpeth, Mrs. Louten Rhodes

1917 N. Walnut St Lumberton

Hedgpeth, Mrs. William Carey

2405 Kenan St Lumberton

Hedrick, Mrs. Clyde Reitzel

318 E. College Ave Lenoir

Hedrick, Mrs. Richard Eli

1999 Georgia Ave Winston-Salem

Hege. Mrs. John Roy, Martin Drive Concord

Heinitsh, Mrs. George W.

Knollwood Southern Pines

Helms, Mrs. Jefferson Bivins

319 W. Union St Morganton

Helsabeck, Mrs. Belmont Augustus

2315 Country Club Rd Winston-Salem

Helsabeck, Mrs. Chester Joseph

Box 236 Walnut Cove

Hemmings, Mrs. Hugh Carroll

Lurawood Dr Morganton

Hemphill, Mrs. Clyde Hoke

P. O. Box 1084 Black Mountain

Hemphill, Mrs. James Eugene

2002 Pinewood Circle Charlotte

Henderson, Mrs. John Percy, Sr.

417 College St Jacksonville

Henderson, Mrs. John Percy, Jr.

107 Warlick St Jacksonville

Hendrick, Mrs. Harry Vance

404 S. Ridgecrest Ave Rutherfordton

Hendricks, Mrs. Paul Eugene

808 W. Mountain St Kings Mountain

Hendrix, Mrs. James Paisley

144 Pinecrest Rd Durham

Henry, Mrs. Hector H.

3535 Providence Rd Charlotte

Henry, Mrs. Russell Cole, 1545 Kings Road, Shelby
Henschen, Mrs. Hal

1309 General Lee Ave Fayetteville

Henson, Mrs. Thomas Albert

1105 Country Club Dr Greensboro

Herrin, Mrs. Keith Hermon

1204 Fairfield Dr Gastonia

Herrin, Mrs. William Benjamin

Carolyn Drive Albemarle

Herring Mrs. Theodore Tilghman

Ripley Road Wilson

Hester, Mrs. Joseph Robert

1 Buffalo St Wendell

Hester, Mrs. William Shepherd

802 Main St Reidsville

Hewitt, Mrs. Willard Chappel

W. Front St. Ext Burlington

Hiatt, Mrs. Joseph Spurgeon, Jr.

Box 85 Southern Pines

Hicks, Mrs. Vonnie Monroe, Jr.

1515 Scales St Raleigh

Higgins, Mrs. Robert Donald

1204 Cowper Dr Raleigh

High, Mrs. Larry Alison Nashville

Highsmith, Mrs. Charles, Jr Troy

Highsmith, Mrs. William Cochran

220 Bradford Ave Fayetteville

Hightower, Mrs. Felda

2455 Reynolds Drive Winston-Salem

Hilderman, Mrs. Walter Carrington, Jr.

1724 Brandon Rd Charlotte

Hill, Mrs. Millard D. Hill

818 Daniels St. Raleigh

Hill, Mrs. William Henry

115 E. South St Albemarle

Hipp, Mrs. Edward Reginald, Sr.

348 Hempstead PI Charlotte

Hitch, Mrs. Joseph Martin, 918 Cowper Dr. Raleigh
Hobart, Mrs. Seth Guilford, Jr.

2011 W. Club Blvd Durham

Hodges, Mrs. Horace Havden

423 Ferncliff Rd Charlotte

Hoggard, Mrs. William Alden, Jr.

2501 Rochelle Elizabeth City

Hogshead, Mrs. Ralph, Jr., W. Park Dr., Morganton
Hoke, Mrs. Harold Reid

1605 Oaklawn Dr. ..._ Greenville

Holbrook, Mrs. Joseph Samuel

223 N. Oak St Statesville

Holbrook, Mrs. William Douglas

2518 Danbury St Charlotte

Hollandsworth, Mrs. Luther Clarence

305 E. 18th St Lumberton

Hollister, Mrs. William Fredwin

Midland Rd Southern Pines

Hollowell, Mrs. Victor Boyce

515 Fenton PI Charlotte

September, 1960

ROSTER OF MEMBERS

425

Hollyday, Mrs. William Murray

51 Lawrence PI Asheville

Holmes, Mrs. George Washington

524 Roslyn Rd Winston-Salem

Holt, Mrs. Lawrence Byerly

2812 Reynolds Dr Winston-Salem

Hood, Mrs. Christopher Kennedy

5143 Beckford Dr. „._ Charlotte

Hood, Mrs. Richard Thornton, Jr.

1109 Carey Rd Kinston

Hooks, Mrs. Richard Eugene St. Pauls

Hooper, Mrs. Joseph Ward, Jr.

2600 Parmelee Dr Wilmington

Hooper, Mrs. Joseph Ward, Sr.

1817 Market St. Wilmington

Hoot, Mrs. Melvin Phillip

1505 E. 5th St Greenville

Horner, Mrs. Jack Chenoweth .Spruce Pine

Hornowski, Mrs. Marcel Jerome

317 Charlotte St Asheville

Horsley, Mrs. Thomas Martin Elizabeth City

Horsley, Mrs. William Nolen

South Point Rd Belmont

Hoskins, Mrs. John Robinson, III

36 Evelyn PI Asheville

Hoskins, Mrs. William Hume

Fuller St Whiteville

Hough, Mrs. Mac Johnson

3234 Park Rd Charlotte

Houghton, Mrs. Raymond C.

1800 River Dr New Bern

Houser, Mrs. Forest Melville, Elm St., Cherryville
Hovis, Mrs. Leighton Watson

810 Berkeley Ave Charlotte

Howard, Mrs. Corbett Etheridge

618 E. Park Ave Goldsboro

Howard, Mrs. Joseph Cooper, Jr.

Lafayette St Clinton

Howard, Mrs. Paul Osman

Carbonton Hgts Sanford

Howell, Mrs. Charles Maitland, Jr.

515 Lester Lane Winston-Salem

Howell, Mrs. Julius Amnions

2662 Robin Hood Rd Winston-Salem

Howell, Mrs. William Lawrence Ellerbe

Howerton, Mrs. James R Columbia

Hubbard, Mrs. Frederick Cecil, Sr Wilkesboro

Hubbard, Mrs. Robert Thomas

126 Lakeshore Dr. Asheville

Huckeriede, Mrs. Mark Henry

Anson Ave Laurinburg

Hudson, Mrs. Miles Hildebrand

240 Bouchard St Valdese

Huey, Mrs. Thomas Walker, Jr.

2438 Sharon Rd Charlotte

Huffines, Mrs. Thomas Ruffin

16 Hilltop Rd Asheville

Huffman, Mrs. Stanton Vance

Route 2 Elon College

Hughes, Mrs. Carlisle Bee, Jr.

Box 326 Yadkinville

Hughes, Mrs. Jack

Route 2, Box 336 Durham

Humphries, Mrs. Charles Oliver

Summerset Road ..Durham

Huneycutt, Mrs. Joel Broadus

627 Yadkin St Albemarle

Hunt, Mrs. Jasper Stewart

2064 Queens Rd., E Charlotte

Hunt, Mrs. Walter Skellie, Jr.

1606 Canterbury Rd Raleigh

Hunt, Mrs. William Jack

720 Ferndale Dr High Point

Hunter, Mrs. John Pullen

325 S. Academy St Cary

Hunter, Mrs. W. Myers

800 E. Blvd Charlotte

Hunter, Mrs. William Blair

1007 10th St Lillington

Hunter, Mrs. William Cooper

1106 W. Nash St Wilson

Hurdle, Mrs. Samuel Walker

2571 Country Club Rd Winston-Salem

Hurdle, Mrs. Thomas Gray

212 Fuller St Fayetteville

Hutchinson, Mrs. Sankey Smith Bladenboro

Hyde, Mrs. Austin Tabor, Jr.

Union Road Rutherfordton

Inman, Mrs. Charles Ernest

Fisher Park Fairmont

Irving, Mrs. Richard Carroll

601 4th Ave. W Hendersonville

Irwin, Mrs. Henderson Eureka

Isenhower, Mrs. Joseph Andrew

232 Fifth St., S. E Hickory

Izlar, Mrs. Henrv LeRoy, Jr.

2202 Sprunt St Durham

Jackson, Mrs. Marshall Vaden, Box 87, Princeton
Jackson, Mrs. Richard DeWitt

909 S. Rockford St Mt. Airy

Jackson, Mrs. Robert Toombus

3347 Alamance Dr Raleigh

Jackson, Mrs. Roger A.

111-A Dobbin Ave Fayetteville

Jacobs, Mrs. Julian Erich John

2000 Providence Rd Charlotte

James, Mrs. Arthur Augustus, Jr.

614 Spring Lane Sanford

James, Mrs. George W.

1020 Wellington Rd Winston-Salem

James, Mrs. Richard Thomas, Jr.

2300 Wendover Rd Charlotte

James, Mrs. William Daniel, Vance St Hamlet

James, Mrs. William Duer, Jr.

306 Entwistle St Hamlet

Jarman, Mrs. Fontaine Graham, Sr.

402 Hamilton St Roanoke Rapids

Jarman, Mrs. Fontaine Graham, Jr.

429 Sunset Ave Roanoke Rapids

Jarrel, Mrs. Wilburn Eric

329 Country Club Rd Mt. Airy

Jarvis, Mrs. James Luther

1003 Woodland Drive Gastonia

Jenkins, Mrs. Albert Milton

823 Bryan St Raleigh

Jennings, Mrs. Royal Green

724 Florham Ave High Point

Jensen, Mrs. Milton Baker

152 Milford Dr Salisbury

Jervey, Mrs. William St. Julien

907 Elizabeth Rd Shelby

Johnson, Mrs. Amos Neill Garland

Johnson, Mrs. Charles Thomas, Jr Red Springs

Johnson, Mrs. Charles Thomas, Sr. ...Red Springs

Johnson, Mrs. Floyd, 201 Pinkney St Whiteville

Johnson, Mrs. Gale Denning

400 W. Broad St Dunn

Johnson, Mrs. Gaston Frank

3225 Nottingham Rd Winston-Salem

Johnson, Mrs. George, Jr., 1312 Watts St., Durham

Johnson, Mrs. Harry Lester, Box 530 Elkin

Johnson, Mrs. Heber Wellington

3002 Wayne Dr. Wilmington

Johnson, Mrs. James Trimble

312 E. 16th Lumberton

Johnson, Mrs. John Ralph, N. Orange St Dunn

Johnson, Mrs. Joseph A.

Winslow Acres Elizabeth City

Johnson, Mrs. Joseph Lewis

205 N. Main St Graham

Johnson, Mrs. Paul William

Route 8, Green Meadows Winston-Salem

Johnson, Mrs. Philip Martyn

220 Hayes St Chapel Hill

426

NORTH CAROLINA MEDICAL JOURNAL

September, 1960

Johnson, Mrs. Robert Charles

701 Locust St High Point

Johnson, Airs. Walter Royle

3 Fairway Place Asheville

Johnson, Mrs. Wingate Memory

428 Stratford Rd Winston-Salem

Johnston, Mrs. Frank Randolph

735 Arbor Rd Winston-Salem

Johnston, Mrs. Harvey Wylie

1915 Club Rd Charlotte

Johnston, Mrs. James William

508 Wildwood Lane Burlington

Johnston, Mrs. Robert Lee

218 N. Patrick St Leaksville

Johnston, Mrs. William Oliver

2611 Forest Dr Charlotte

Jones, Mrs. Beverly Nicholas, Jr.

633 Barnesdale Rd Winston-Salem

Jones, Mrs. Beverly Nicholas, Sr.

455 Carolina CI Winston-Salem

Jones, Mrs. Carey C, S. Salem St Apex

Jones, Mrs. Claude M., 509 E. 4th St., Greeenville
Jones, Mrs. Clayton Joe, 873 Arbor Lane, Concord
Jones, Mrs. Craig Strickie

Westfield Road Shelby

Jones, Mrs. Dean Cicero Jefferson

Jones, Mrs. Donnie Hue, Jr., Box 67 Princeton

Jones, Mrs. Edward L.

400 Randolph St Thomasville

Jones, Mrs. Frank Woodson

Westlake Hills Newton

Jones, Mrs. Joseph Kempton

109 E. Boundary St Chapel Hill

Jones, Mrs. Joseph Reid, Jr., Box 298 King

Jones, Mrs. Martin Evans Granite Falls

Jones, Mrs. Otis Hunter

1710 Queens Rd. W Charlotte

Jones, Mrs. Paul Erastus

Rt. 3, Box 452A Concord

Jones, Mrs. Robert Spurgeon

405 Beaumond Shelby

Jones, Mrs. Thomas Thweatt

2621 Stuart Dr Durham

Jones, Mrs. William Robert

217 Clifton Rd Rocky Mount

Jordan, Mrs. John Alfred, Jr.

236 Pinecrest Dr Fayetteville

Jordan, Mrs. Riley Moore

310 Fulton St. Ext Raeford

Jordan, Mrs. Weldon Huske

601 Westmont Dr Fayetteville

Joyce, Mrs. Charles Weldon

617 Decatur Madison

Joyner, Mrs. William Stafford

401 Whitehead Circle Chapel Hill

Judd, Mrs. Glenn Ballentine Varina

Justa, Mrs. Samuel Harry

505 Piedmont Ave Rocky Mount

Justice, Mrs. William Shipp

14 White Oak Rd Asheville

Justis, Mrs. Homer Rodeheaver

820 Fairbanks Rd Charlotte

Kalevas, Mrs. Harry John

5415 Wedgewood Dr Charlotte

Katz, Mrs. Joseph, Kinston Apts Kinston

Kearse, Mrs. William Oliver Canton

Keathley, Mrs. Franklin Burr

206 Grove Ave Lenoir

Keever, Mrs. James Woodfin

623 Second Ave., N. W Hickory

Keiter, Mrs. William Eugene

1507 Perry Park Dr Kinston

Keith, Mrs. Julian Faison, Jr., Box 635, Clarkton
Keith, Mrs. Marion Yates

1603 Carlisle Rd Greensboro

Keleher, Mrs. Michael Francis

18 Maywood Rd Asheville

Kelemen, Mrs. William Arthur

1206 Kennilworth Ave Charlotte

Keller, Mrs. Guy Otis

1223 Providence Charlotte

Kelley, Mrs. Thomas Francis

805 Montgomery Ave Albemarle

Kelly, Mrs. Luther Wrentmore, Jr.

3915 Shelton Place Charlotte

Kelly, Mrs. Luther Wrentmore, Sr.

1014 Kenilworth Ave Charlotte

Kelly, Mrs. Richard Alexander

308 N. Chapman Greensboro

Kemp, Mrs. Malcolm Drake

210 Highland Rd Southern Pines

Kenan, Mrs. LeRoy Fulton

22 Henderson St. Badin

Kendall, Mrs. Benjamin Horton

116 Belvedere Ave Shelby

Kendall, Mrs. John Harold

800 Stewart Ave. Clinton

Kendriek, Mrs. Charles Mattox

103 Poplar St Lenoir

Kendriek, Mrs. Richard L.

2500 Roswell Ave Charlotte

Kennard, Mrs. John William

Maple St Blowing Rock

Kennedy, Mrs. John Pressly

2026 Providence Rd Charlotte

Kennedy, Mrs. Leon Toland

1907 Sterling Rd Charlotte

Kennel, Mrs. Arthur J Jefferson

Kent, Mrs. Alfred A., Jr Granite Falls

Kermon, Mrs. Louis Todd

1625 Canterbury Rd Raleigh

Kern, Mrs. John Campbell, Box 6 Booneville

Kernodle, Mrs. Charles Edward, Jr.

444 Tarleton Ave Burlington

Kernodle, Mrs. Donald Reid

1-D Brookwood Garden Apts Burlington

Kernodle, Mrs. Dwight Talmadge

Route 2 Elon College

Kernodle, Mrs. Harold Barker

423 Glenwood Ave Burlington

Kernodle, Mrs. John Robert

Edgewood Ave. Ext Burlington

Kems, Mrs. Thomas Cleveland, Sr.

120 Briar Cliff Rd Durham

Kerns, Mrs. Thomas Cleveland, Jr.

1118 Wells St Durham

Kerr, Mrs. George Russell

Woodland Ave. Ext Burlington

Kerr, Mrs. John Guthrie Leicester

Kerr, Mrs. Joseph T.

1423 Kenan Ave Wilson

Kesler, Mrs. Robert Cicero

705 Twyckenham Dr Greensboro

Kester, Mrs. John Marcas, Jr.

2935 Avondale Ave Charlotte

Ketner, Mrs. Fred Yadkin

185 Washington Lane Concord

Keys, Mrs. Carson Meade West Jefferson

Kibler, Mrs. William Herbert

100 Valdese Ave Morganton

Kidd, Mrs. Ralph Vincent, Jr.

1227 Canterbury Rd Charlotte

King, Mrs. Daniel, 611 Maple Ave Reidsville

King, Mrs. Edward Sandling, Wesson Road, Shelby
King, Mrs. Francis Parker

1603 Lucerne Way New Bern

King, Mrs. Parks McCombs

1419 Wendover Lane Charlotte

King, Mrs. Robert Wilson

113 Dobbin Ave Fayetteville

King, Mrs. Walter Gorringe

1305 Latham Rd - Greensboro

Kinlaw, Mrs. Murray Carlyle

202 W. 21st St Lumberton

September, 1960

ROSTER OF MEMBERS

427

Kirby, Mrs. William Leslie

734 Arbor Rd Winston-Salem

Kirkland, Mrs. John Alvin, 715 Trinity Dr., Wilson

Kirksey, Mrs. James Jackson

Riverside Dr Morganton

Kirksey, Mrs. William Albert

302 S. King St Morganton

Kistler, Mrs. Clark Clemmons

2212 St. Mary's St Raleigh

Kitchin, Mrs. Thurman Delna

413 N. Main St Wake Forest

Kitchin, Mrs. William Walton

Coharie Dr Clinton

Klenner, Mrs. Fred Robert Reidsville

1205 Forest Road Reidsville

Klostermyer, Mrs. Louis Leon

419 Vanderbilt Rd Asheviiie

Kneedler, Mrs. William Harding, Box 397, Davidson
Knight, Mrs. Floyd Lafayette, Route 4, Sanford
Knoefel, Mrs. Arthur Eugene, Jr.

104 Laurel Circle Black Mountain

Knox, Mrs. Joseph Clyde

1228 S. Live Oak Parkway Wilmington

Kodack, Mrs. Albert

9 N. Kensington Rd Asheviiie

Koon, Mrs. Ethen Sease, Jr.

159 Kimberly Ave Asheviiie

Koonce, Mrs. Donald Brock

1407 Oleander Dr Wilmington

Kornegay, Mrs. Robert Dumais

1418 Lafayette Ave Rocky Mount

Koseruba, Mrs. George Michael

18 E. Fayetteville Wrightsville Beach

Kramer, Mrs. Morris

503 Walnut St Lumberton

Kroh, Mrs. Laird Franklin

2201 McClintock Rd Charlotte

Kroncke, Mrs. Fred George

623 Cedar St Roanoke Rapids

Kurtz, Mrs. Elam Jefferson

Kutscher, Mrs. George William

29 Elk Mountain Scenic Hwy Asheviiie

Kutteh, Mrs. Hanna Constantine

567 Lakeside Dr Statesville

Kyles, Mrs. Norman Bruce

State Hospital Goldsboro

Lackey, Mrs. Robert Stevenson

3931 Shelton PI Charlotte

Lackey, Mrs. Walter Jackson Fallston

Lacy, Mrs. Thomas Allen

608 S. Fulton St Salisbury

Lafferty, Mrs. John Ogden

2059 Briarwood Road Charlotte

Lafferty, Mrs. John William

1055 Fourth Ave., N.W Hickory

Lahser, Mrs. Charles Irvin

1212 Crescent Ave Gastonia

Lake, Mrs. Ralph Callihan

4500 Starmount Dr Greensboro

Lambeth, Mrs. William Arnold, Jr.

Route 8 Winston-Salem

Lampley, Mrs. Charles Gordon. Fairway Dr., Shelby
Lampley, Mrs. William Askew

116 Briarwood Lane Hendersonville

Landon, Mrs. Henry C, III

611 Eighth St North Wilkesboro

Lane, Mrs. Edgar Winslow, Jr.

Bouchard St. Valdese

Lang, Mrs. Andrew Martin

106 N. Anderson St Morganton

Langdell, Mrs. Robert Dana

11 William Circle Chapel Hill

Langdon, Mrs. Benjamin Bruce

Route 3, Box 40 Fayetteville

Lapsley, Mrs. Alberti Fraser, 4 Tallassee St., Badin
Large, Mrs. Hiram Lee, Jr.

Route 1, Box 358-B Matthews

Larkin, Mrs. Ernest Wadill, Jr.

1202 Respass St Washington

Lassiter, Mrs. James Alexander

Country Club Rd Weldon

Lassiter, Mrs. Tallie E Biscoe

Lassiter, Mrs. Will Hardee, Jr.

709 Sunset Dr Smithfield

Latham, Mrs. Joseph Roscoe

1301 National Ave New Bern

Laton, Mrs. James Franklin

116 E. North St Albemarle

La Tourette, Mrs. Kenneth Abran, Hendersonville
Lawing, Mrs. Karl Lander

327 N. Laurel St Lincolnton

Lawrence, Mrs. Benjamin Jones

Ashton Hall Pace, Virginia

Lawrence, Mrs. Benjamin Jones, Jr.

S. 915 Rockford St Mt. Airy

Lawrence, Mrs. John Charles

1200 N. Elm Lumberton

Lea, Mrs. James Walter, Jr.

721 W. Davis St Burlington

Leath, Mrs. MacLean Bacon Archdale

LeBauer, Mrs. Maurice Leon

2223 St. Andrews Rd Greensboro

LeBauer, Mrs. Sidney Ferring

910 Cornwallis Dr Greensboro

Ledbetter, Mrs. James McQueen

701 E. Washington St Rockingham

Lee, Mrs. Allen Henry, 309 N. Massey Selma

Lee, Mrs. Ferdinand Wayne

442 Hempstead Charlotte

Lee, Mrs. Francis Brown, Pageland Rd Monroe

Lee, Mrs. Thomas Leslie, Rountree St Kinston

LeGrand, Mrs. Robert Hampton

2014 Pembroke Rd Greensboro

Leinbach, Mrs. Lawrence Brickenstein

260 Kenleigh Circle Winston-Salem

Lennon, Mrs. Hershel Clanton

911 Sunset Dr Greensboro

Lentz, Mrs. Clarence Manteo

317 N. Fifth St Albemarle

Leonard, Mrs. Jacob Calvin, Jr.

Box 566 Lexington

Leonard, Mrs. Walter Evan

104 27th St., N.W Hickory

Levi, Mrs. George Albert

605 Pearl St Fayetteville

Lewis, Mrs. Charles Pell, Jr.

813 S. Main Reidsville

Lewis, Mrs. Clifford Whitfield

322 Woodrow High Point

Lewis, Mrs. John Sumter

362 N. Center St Hickory

Lewis, Mrs. Martin Thomas Beaufort

Lewis, Mrs. Robert Edward

Finley Park North Wilkesboro

Lide, Mrs. Thomas Norwood

601 Barnsdale Rd Winston-Salem

Ligon, Mrs. Harold Belton

43 Beverly Apt Asheviiie

Liles, Mrs. George Welch, 257 Louise Ave., Concord
Liles, Mrs. Lonnie Carl

3025 Randolph Dr Raleigh

Lilly, Mrs. James M.

226 Bradford Rd Fayetteville

Lilly, Mrs. William Harold, Benson Highway, Dunn
Lindsay, Mrs. Robert Boyd

730 Gimghoul Rd Chapel Hill

Lindsey, Mrs. Mark McDonald

415 Minturn Ave Hamlet

Link, Mrs. Melvin Robert

1050 Ardsley Rd Charlotte

Little, Mrs. Howard Q. L., Box 205 Gibsonville

Little, Mrs. Joseph Rice, Oak Rd Salisbury

Littlejohn, Mrs. James Talmadge

8 Cedarcliff Rd Asheviiie

428

NORTH CAROLINA .MEDICAL JOURNAL

September, 1960

Littlejohn, Mrs. Thomas Willard

2402 Forest Dr Winston-Salem

Littleton, Mrs. Leonidas Rosser, Jr Mt. Airy

Liverman, Mrs. Henry Joseph Engelhard

Liverman, Mrs. Joseph Thomas Nashville

Llewellyn, Mrs. Charles Elroy, Jr.

3525 Hamstead Court Durham

Lock, Mrs. Frank Ray

1819 Buena Vista Rd Winston-Salem

Lockhart, Mrs. David Armistead

Rt. 3, Burrage Rd Concord

Lockhart, Mrs. Walter Samuel, Jr.

2408 Highland Ave Durham

Lodmell, Mrs. Elmer Arthur

1308 Cornwallis Greensboro

Logan, Mrs. Frank William Hicks

1007 N. Washington Rutherfordton

Lomax, Mrs. Donald Henry

1125 Emerald St Salisbury

London, Mrs. Arthur Hill, Jr.

Shepherd and Wells Sts Durham

Long, Mrs. Benjamin Leroy Glen Alpine

Long, Mrs. David Thomas

405 S. Main St Roxboro

Long, Mrs. Glenn, 630 N. Main St Newton

Long, Mrs. Thomas Drumwright

513 S. Lamar St. Roxboro

Long, Mrs. Thomas Walter, N. Main St., Newton
Long, Mrs. Vann McKee

1021 West End Blvd Winston-Salem

Long, Mrs. William Lunsford, Jr.

1103 Cowper Dr Raleigh

Long, Mrs. William Matthews Mocksville

Long, Mrs. Zachary Filmore

214 Ann St Rockingham

Longino, Mrs. Frank Henry

1914 Forest Hill Dr Greenville

Lore, Mrs. Ralph Eli, 407 Pennton Ave Lenoir

Lott, Mrs. William Clifton

310 Vanderbilt Rd Asheville

Lounsbury, Mrs. James Breckinridge

2519 Guilford Ave Wilmington

Lovelace, Mrs. Thomas Claude Henrietta

Lovell, Mrs. William Figgatt

1517 Biltmore Dr Charlotte

Lovill, Mrs. Robert Jones, Box 647 Mt. Airy

Lowery, Mrs. Charles D Lowell

Lowery, Mrs. John Robert

1620 Wiltshire Salisbury

Lownes, Mrs. Milton Markley, Jr.

Redwheel Farm Dudley

Lubchenko, Mrs. Nicholas Eleazer Harrisburg

Lucas, Mrs. Robert Theodore, Jr.

944 Henley Place Charlotte

Lumb, Mrs. George Dennett

1325 Hawthorne Road Wilmington

Lund, Mrs. Herbert Zachareus

3610 Kirby Dr Greensboro

Lunsford, Mrs. Lewis, Jr.

20 Hy-Vu Drive Asheville

Lupton, Mrs. Carroll Crescent

3300 Starmount Dr Greensboro

Lupton, Mrs. Emmett Stevenson Alamance

Lusk, Mrs. John A., Ill

1800 W. Market St Greensboro

Lusk, Mrs. Walter Coles, 946 Hill St., Greensboro
Lutterloh, Mrs. Isaac Hayden, Sr.

202 Mclver St Sanford

Lutterloh, Mrs. Isaac Hayden, Jr.

510 Walnut Dr Sanford

Lutz, Mrs. James Dwight

1125 Highland Ave Hendersonville

Lyday, Mrs. Charles Emmett

819 S. York St Gastonia

Lyday, Mrs. Russell Osborne

1610 Nottingham Rd Greensboro

Lvmberis, Mrs. Marvin Nicholas

2111 Radcliffe Ave Charlotte

Lynch, Mrs. John Franklin, Jr.

905 Arbordale Dr High Point

Lynn, Mrs. Cy Kellie, Bouchard St. Valdese

Lynn, Mrs. James Wiley, Jr.

Rock wood Acres Burlington

Lynn, Mrs. William S., Bristol Road Durham

Lyon, Mrs. Brockton Reynolds

Country Club Apts ..Greensboro

McAdams, Mrs. Charles Rupert, Sr.

31 W. Woodrow Ave Belmont

McAdams, Mrs. Charles Rupert, Jr.

Route 4, Sardis Rd Matthews

McAllister, Mrs. Hugh Alexander

Riverside Dr Lumberton

McArn, Mrs. Hugh Munroe,

701 Anson Ave Laurinburg

McBryde, Mrs. Angus Murdoch

411 E. Forest Hills Blvd Durham

McCain, Mrs. John Lewis, 1601 Highland, Wilson

McCall, Mrs. Michael Alvin Marion

McCall, Mrs. William, Jr.

508 Walter Court Winston-Salem

McCarthy, Mrs. John Joseph

N. C. Sanatorium McCain

McCarty, Mrs. Ralph Leeves

843 Hempstead PI Charlotte

McClees, Mrs. Edward Count Elm City

McClelland, Mrs. Joseph O Maxton

McConnell, Mrs. Harvey Russell

1119 Cumberland Ave Gastonia

McCoy, Mrs. Joseph Bennett, Jr.

2026 Sharon Lane Charlotte

McCracken, Mrs. Joseph Pickett

126 Pinecrest Rd Durham

McCracken, Mrs. Marvin Howell

28 Griffing Blvd Asheville

McCutchan, Mrs. Frank

Wilshire Dr., Milford Hills Salisbury

McDonald, Mrs. Con T.

1106 S. Madison Ave Goldsboro

McDowell, Mrs. Harold Clyde

200 Arbor Rd Winston-Salem

McDowell, Mrs. Roy Hendrix

20 Myrtle St Belmont

McEaehern, Mrs. Duncan Roland

1915 Hydrangea PI Wilmington

McElrath, Mrs. Percy John

2736 Toxey Dr Raleigh

McElwee, Mrs. Ross S., Jr.

2817 Belvedere Ave Charlotte

McFadyen, Mrs. Oscar Lee, Jr.

524 Valley Rd Fayetteville

McGavran, Mrs. Edward G.

Greenwood Rd Chapel Hill

McGee, Mrs. Julian Murrill

811 N. Elm St Greensboro

McGill, Mrs. John Charles

506 Crescent Hill Kings Mountain

McGill, Mrs. Kenneth Harwood

505 Crescent Hill Kings Mountain

McGimsey, Mrs. James Franks, Jr.

Edgewood St Morganton

McGowan, Mrs. Claudius Plymouth

McGowan, Mrs. Joseph Francis

303 Vanderbilt Rd Asheville

McGrath, Mrs. Frank Bernard

212 E. 17th St Lumberton

McGuffin, Mrs. William Christian

52 Forest Rd Asheville

Mcintosh, Mrs. Henry Deane

2406 N. Duke St Durham

McKee, Mrs. John Sasser, Jr.

State Hospital Morganton

McKee, Mrs. Lewis Middleton

3633 Hope Valley Ed Durham

McKenzie, Mrs. Edward Burt

329 Summit Ave Salisbury

September, 1960

ROSTER OF MEMBERS

429

McKenzie, Mrs. Wayland Nash
N. Tenth St

..Albemarle

McKinnon, Mrs. George Edward
1836 Harris Road

.Charlotte

McKinnon, Mrs. William James

501 W. Wade St Wadesboro

McLain, Mrs. Bill Reid, Box 328 Troutman

McLain, Mrs. John Edward G.

3916 Rugby Rd Durham

McLaurin, Mrs. Daniel Archie, Box 487 ....Dobson
McLean, Mrs. Ewen Kenneth

1110 Queens Rd., W Charlotte

McLean, Mrs. James Wilton

217 DeVane St Fayetteville

McLendon, Mrs. Walter Jones, Box 116, Oakboro
McLeod, Mrs. John Calvin, Jr.

707 Pou St Goldsboro

McLeod, Mrs. John Purl Uttley Marshviile

McLeod, Mrs. William Leslie

1504 Biltmore Dr ; Charlotte

McLeod, Mrs. William Louis, S. Main St., Norwood
McManus, Mrs. Hugh Forrest, Jr.

3331 White Oak Rd Raleigh

McMillan, Mrs. James Fulford

907 Live Oak Pkwy Wilmington

McMillan, Mrs. Robert Lindsay

718 Arbor Rd Winston-Salem

McMillan, Mrs. Robert Monroe

Massachusetts Ave. Ext Southern Pines

McMillan, Mrs. Roscoe Drake

414 S. Main St Red Springs

McMillan, Mrs. Thomas Henry, Jr.

1412 Scott Court Charlotte

McMurry. Mrs. Avery Willis

106 Hillside Dr Shelby

McNeill, Mrs. Claude Ackle, Jr.

121 Church St Elkin

McNeill, Mrs. James Hubert

Pilson St North Wilkesboro

McNiel, Mrs. Thomas Lee

N. Brook St Wilkesboro

McPheeters, Mrs. Samuel Brown

307 Linwood Ave Goldsboro

McPherson, Mrs. Charles Wade

422 Fountain PI. ..._ Burlington

McPherson, Mrs. Harry Thurman

3200 Oxford Dr _ Durham

McPherson, Mrs. Samuel Dace, Jr.

29 Oak Dr _ Durham

McRae, Mrs. James Thomas Elkin

McRae, Mrs. Marvin Everett

121 Beverly PI _ Greensboro

McRee, Mrs. Jean Douglas

808 Runnymeade Rd Raleigh

McWhorter, Mrs. Robert Ligon

905 Martin Dr Concord

Mabe, Mrs. Paul Alexander

122 Penrose Dr Reidsville

MacAlpine, Mrs. Orville Duncan, Route 2, Chandler
Macatee, Mrs. George, Jr.

25 Inglewood Rd Asheville

MacDonald, Mrs. J. Kingsley

3600 Barclay Downs Dr Charlotte

MacKay, Mrs. James Calvin

1805 Grace St Wilmington

Mackie, Mrs. George Carlyle, Box 927, Wake Forest

MacLauchlin, Mrs. William Thompson Conover

Macon, Mrs. Gideon Hunt Warrenton

MacRae, Mrs. John Donald

2813 Skye Dr Fayetteville

Maddrey, Mrs. Milner Crocker

610 Franklin St Roanoke Rapids

Maher, Mrs. James A.

Route 5, Box 249 Goldsboro

Major, Mrs. Richard Smart

816 Fourth Ave., W Hendersonville

Maloney, Mrs. George R., Route 6 Fayetteville

Maness, Mrs. Archibald Kelly

1918 Granville Rd Greensboro

Maness, Mrs. Paul Franklin

1010 Central Ave Burlington

Mangum, Mrs. Carlyle Thomas, Jr.

Highland Drive Leaksville

Manly, Mrs. Isaac Vaughan

2215 Lakeview Dr Raleigh

Manly, Mrs. James Hollowell, Jr.

2100 St. James Rd Raleigh

Manning, Mrs. Isaac Hall, Jr.

3901 Hope Valley Rd Durham

Marder, Mrs. Gerard

Armstrong Park Rd Gastonia

Marks, Mrs. Edgar Seymour

1112 Hamel Rd. Greensboro

Marr, Mrs. James Tilden

1718 Virginia Rd Winston-Salem

Marsh, Mrs. Frank Baker

725 Lake Drive Salisbury

Marshall, Mrs. Jamej Flournoy

341 Arbor Rd Winston-Salem

Marshburn, Mrs. Elisha Thomas, Jr.

218 Brightwood Rd ...Wilmington

Martin, Mrs. Benjamin Franklin

2560 Warwick Rd Winston-Salem

Martin, Mrs. Dan Anderson

Sourwood Drive Chapel Hill

Martin, Mrs. James Alfred

1305 Walnut St Lumberton

Martin, Mrs. James Franklin

734 Roslyn Rd Winston-Salem

Martin, Mrs. Moir Saunders

314 Cherry St Mt. Airy

Martin, Mrs. Sidney Arnold

2711 Fairview Rd Raleigh

Martin, Mrs. William Francis

1534 Queens Rd., W Charlotte

Mason, Mrs. Lockert Bemiss

824 Country Club Rd Wilmington

Mason, Mrs. Manly Newport

Mason, Mrs. Philip, 808 Henkel Rd. Statesville

Massey, Mrs. Charles Caswell

1318 Carlton Ave Charlotte

Matheson, Mrs. Robert Arthur

Drawer 608 Raeford

Matthews, Mrs. Hugh Archie Canton

Matthews, Mrs. James H.

8 Mt. Vernon Circle Asheville

Matthews, Mrs. Roland Dellwood

147 Tarleton Ave Burlington

Matthews, Mrs. Vann M.

3010 Central Ave Charlotte

Matthews, Mrs. William Camp

645 Hempstead PI Charlotte

Matthews, Mrs. William Walter

Oakland Heights Leaksville

Maulden, Mrs. Paul Ranzo

204 William St Kannapolis

Mauzy, Mrs. Charles Hampton, Jr.

1820 Greenbriar Rd. Winston-Salem

Maxwell, Mrs. Clarence Schuyler Beaufort-
May, Mrs. Harvey Craig

1136 Berkeley Ave Charlotte

May, Mrs. William Joseph

1824 Georgia Ave Winston-Salem

Mayer, Mrs. Walter Brem

2828 St. Andrews Lane Charlotte

Maynard, Mrs. Eugene Vincent

P. O. Box 155 Elm City

Meadows, Mrs. Joseph Herman

108 Clyde Ave Wilson

Means, Mrs. Robert Lee

122 Revere Rd Winston-Salem

Mease, Mrs. Willis Eugene Richlands

Mebane, Mrs. Giles Yancey, Carr Street ....Mebane
Mebane, Mrs. John Gilmer

Tryon Rd Rutherfordton

430

NORTH CAROLINA MEDICAL JOURNAL

September, 1960

Mebane, Mrs. William Carter, Jr.

4507 Wrightsville Ave Wilmington

Medlin, Mrs. Joseph Robert, Jr. Rural Hall

Mees, Mrs. Theodore Howell

Maxton Rd Lumberton

Melero, Mrs. Andres Tarcisio

Newell Heights Roxboro

Melton, Mrs. Robert Allen

Route 3, Box 192, Pirate's Cove Wilmington

Menefee, Mrs. Elijah Eugene, Jr.

2203 Cranford Rd Durham

Menzies, Mrs. Henry Harding

814 Oaklawn Ave Winston-Salem

Merritt, Mrs. Jesse Frederic

1615 S. College Park Dr Greensboro

Merritt, Mrs. John Hamlett

Barnette Ave Roxboro

Meschan, Mrs. Isadore

751 Roslyn Rd Winston-Salem

Metcalf, Mrs. Lawrence Edward

Chunns Cove Rd Asheville

Mewborn, Mrs. John Moses Farmville

Miller, Mrs. Andrew C, III

110 W. Mauney Circle Gastonia

Miller, Mrs. Cameron Eugene Jefferson

Miller, Mrs. Emery Clyde, Jr.

438 Lynn Ave Winston-Salem

Miller, Mrs. George Rolfe

1040 Paramount Circle Gastonia

Miller, Mrs. Harry, 108 Facility Dr., Fayetteville
Miller, Mrs. Henry Rankin

Fairway Drive Black Mountain

Miller, Mrs. Ira Ben

1007 Westwood High Point

Miller, Mrs. Joseph Teles

914 Springdale Lane Gastonia

Miller, Mrs. Lloyd Davis Marion

Miller, Mrs. Oscar Lee

314 Fenton Place Charlotte

Miller, Mrs. Robert Carlysle

414 Harvie St Gastonia

Miller, Mrs. Robert Evans

1101 Boiling Rd Charlotte

Miller, Mrs. Walton Hoy, Jr.

1606 E. Mulberry St Goldsboro

Miller, Mrs. Wan-en Edwin

502 Pinkney St Whiteville

Milhken, Mrs. James Shepard

, B?x 55 Southern Pines

Milling, Mrs. James Reaves Waynesville

Millman, Mrs. Theodore Harris

l?5 Glovinia St Leaksville

Mills, Mrs. Hugh Harrison

McCall Ra Forest Citv

Mills, Mrs. Wardell Hardee " '

1202 Country Club Dr Greensboro

Minges, Mrs. Ray Donald

Longmeadow Rd Greenville

Minick, Mrs. James Elder, E. Main St., Booneville
Mitchell, Mrs. George William

807 W. Kenan St Wilson

Mitchell, Mrs. Landis Patterson

Huntley St Spindale

Mitchell, Mrs. Rov Colonel Mt Airy

Mitchener, Mrs. Calvin Chambers

4865 Stafford CI Charlotte

Mitchener, Mrs. James Samuel, Jr.

Westwood Laurinburg

Mock, Mrs. Charles Glenn

l1,7 Greylyn Dr Charlotte

Mock, Mrs. Frank Lowe, Route 3 ... Lexington

Mohr, Mrs. Jack Elmer, 207 E. 17th Lumberton

Monroe, Mrs. Clement Rosenburg

Thayer Cottage Pinehurst

Monroe, Mrs. Daniel Geddie

204 Churchill Dr ..Fayetteville

Monroe, Mrs. Edwin Wall

215 Library St Greenville

Monroe, Mrs. John Howard

2642 Philip St Winston-Salem

Monroe, Mrs. Lance Truman

218 N. Union St Concord

Montgomery, Mrs. John Christian, Jr.

2017 Radcliffe Ave. Charlotte

Montgomery, Mrs. John Christian, Sr.

1532 Queens Rd Charlotte

Montgomery, Mrs. Wayne Swope

55 Sunset Parkway Asheville

Montgomery, Mrs. William Gardner

Box 990 urianits Quarry

Moon, Mrs. Richard Young

49 Plymouth Circle ...Asheville

Moore, Mrs. Burmah Dixon

McAdenville Road Mount Hollv

Moore, Mrs. D. Forrest, Box 136 Shelby

Moore, Mrs. Davis Lee

503 E. 5th St Greenville

Moore, Mrs. Edward Eugene

32 Fail-way Rd Asheville

Moore, Mrs. Horace Greeley, Jr.

2905 Harvard Dr Wilmington

Moore, Mrs. James LeGrant

2513 Colton Place Ralegh

Moore, Mrs. John Andrew

1513 Independence Rd Greensboro

Moore, Mrs. Julian Alison

34 Hilltop Rd Asheville

Moore, Mrs. Laurie Walker Beaufort

Moore, Mrs. Ralph Bryan

1339 Hawthorne Rd Wilmington

Moore, Mrs. Robert Alexander

2415 Warwick Rd Win ;ton-Salem

Moore, Mrs. Robert Alexander, Jr.

605 Jennings Drive Wilmington

Moore, Mrs. Robert Ashe

1734 Queens Rd., W Charlotte

Moore, Mrs. Robert Love

311 W. Washington St Bessemer City

Moore, Mrs. Roy Hardin Canton

Moore, Mrs. William Locke

616 Myers Lane Greensboro

Moorefield, Mrs. Robert Hoyle

203 East E St Kannapolis

Mordecai, Mrs. Alfred

806 S. Hawthrone Rd Winston-Salem

Morehead, Mrs. Robert Page

1051 Arbor Rd Winston-Salem

Morey, Mrs. Milton B Morehead City

Morgan, Mrs. Arthur Elwooc!

2853 Skye Dr Fayetteville

Morgan, Mrs. Benjamin Edward

1205 Alta Vista Lane Rocky Mount

Morgan, Mrs. Burnice Earl

2 Cedarcliff Rd Asheville

Morgan, Mrs. Charles Hermann

1408 S. York St Gastonia

Morgan, Mrs. Grady Alexander

1 Cambridge Rd Asheville

Moricle, Mrs. Charles Hunter

1302 South Park Dr Reidsville

Morris, Mrs. Donald Shonk

2398 Warwick Rd Winston-Salem

Morris, Mrs. James Francis

803 S. Madison Ave Goldsboro

Morris, Mrs. John Watson Morehead City

Morris, Mrs. Leslie Morgan

1122 S. Edgemont Ave Gastonia

Morris, Mrs. Marshal Glenn, Jr.

3700 Starmount Dr Greensboro

Morris, Mrs. Rae Henderson

67 Louise Ave Concord

Morrison, Mrs. Frank Waynesville

Morrison, Mrs. Robert Holcombe

331 Fairfield Rd Fayetteville

Morrison, Mrs. Roger William

65 Sunset Parkway Asheville

September, 1960

ROSTER OF MEMBERS

431

Morton, Mrs. Levi Thomas

2601 Cloister Dr Lincolnton

Moseley, Mrs. Charles Herbert Clyde

Moss, Mrs. George Oren

Cleghom Rd Rutherfordton

Moss, Mrs. Paul Hudson

Muirhead, Mrs. Samuel John

Veterans Hospital Salisbury

Mullen, Mrs. Malcolm Preston

1813 W. Nash St Wilson

Murchison, Mrs. David Reid

315 S. Third St Wilmington

Murphy, Mrs. Gibbons Westbrook

22 Hampstead Rd Asheville

Murphy, Mrs. Thomas Lynch

409 Mocksville Ave Salisbury

Myers, Mrs. Alonzo Harrison

414 Fenton PI Charlotte

Myers, Mrs. Richard Thomas

600 Kingsbury Circle Winston-Salem

Nailling, Mrs. Richard Cabot

85 St. Dunstans Rd. Asheville

Nalle, Mrs. Brodie C, Sr.

906 S. College St Charlotte

Nance, Mrs. Charles Lee

1825 E. 7th St Charlotte

Nance, Mrs. Frederick Lee, Jr.

Route 3, Box 130M Kannapolis

Nance, James Edwin

P. O. Box 367 Kannapolis

Nance, Mrs. John Wesley

410 Powell St Clinton

Nanzetta, Mrs. Leonard Anes

2756 Windsor Rd Winston-Salem

Nash, Mrs. Thomas Palmer, III

306 E. Colonial Elizabeth City

Naumoff, Mrs. Phillip, 2320 Croydon Rd., ..Charlotte

Neal, Mrs. John William, Main Street Gibson

Neal, Mrs. Joseph Walter

1344 Brooks Ave. Raleigh

Neal, Mrs. Rutherford Douglas

2532 Hampton Ave Charlotte

Neeland, Mrs. Eugene Crawford

1506 Grove St Wilson

Neese, Mrs. Kenneth Earl

611 Lancaster Ave Monroe

Nelson, Mrs. Charlotte

2205 Woodview Rd Kinston

Nelson, Mrs. Sully Ayden

Nelson, Mrs. William Howell, Box 328 Clinton

Netsky, Mrs. Martin George

1030 Deepwood Court Winston-Salem

Neville, Mrs. Cecil Howell Scotland Neck

Newell, Mrs. Ernest T., 314 Cooper St Dobson

Newman, Mrs. Glenn Carraway

Coharie Dr Clinton

Newman, Mrs. Harold Hastings, Jr.

11 Oak Rd _ Salisbury

Newsome, Mrs. Henry Clay

Box 385 Pilot Mountain

Newton, Mrs. Howard Lowell

244 Hempstead PI Charlotte

Newton, Mrs. William King

Finley Park North Wilkesboro

Niblock, Mrs. Franklin Chalmers, Jr.

136 S. Union St Concord

Nichols, Mrs. Austin Flint, Box 498 Roxboro

Nichols, Mrs. Rhodes Edmond, Jr.

1626 University Dr Durham

Nichols, Mrs. Thomas Rogers

306 W. Union St Morganton

Nicholson, Mrs. Henry Hale, Jr.

1822 Lynwood Rd Charlotte

Nicholson, Mrs. William McNeal

824 Anderson St Durham

Nifong, Mrs. Frank Miller Clemmons

Noble, Mrs. Baxter G., 604 Rudolph Goldsboro

Noel, Mrs. George Thompson

407 Knollwood Dr Kannapolis

Nolan, Mrs. James Onslow

300 Cannon Blvd. Kannapolis

Norfleet, Mrs. Charles Millner, Jr.

2566 Warwick Rd Winston-Salem

Norment, Mrs. William Blount

702 Woodland Dr Greensboro

Norris, Mrs. Louis Jerome, Jr Morehead City

North, Mrs. Ellsworth Howard, Jr.

Riverview Crescent Elizabeth City

Norton, Mrs. Howard Binning

Route 1, Mills River Valley Horse Shoe

Norton, Mrs. John W. Roy

2129 Cowper Dr Raleigh

Nowlan, Mrs. Fagg Bernard Pleasant Garden

Nowlin, Mrs. George Preston

946 Bromley Rd Charlotte

Nunnery, Mrs. William Ernest

632 S. Main _ Rutherfordton

O'Briant, Mrs. Albert Lee, P. O. Box 245, Raeford
O'Brien, Mrs. Paul Stevens

1429 E. Chaloner Dr Roanoke Rapids

Odom, Mrs. Guy Leary

2812 Chelsea CI., Hope Valley Durham

Odom, Mrs. Robert Edwin

99 Evelyn Place Asheville

Odom, Mrs. Robert Taft

1809 Virginia Rd Winston-Salem

Oehlbeck, Mrs. Luther William F., Jr

214 Poplar St Lenoir

Oehlbeck, Mrs. Luther William F., Sr.

618 Third Ave., N. W Hickory

Oelrich, Mrs. August M.

613 Palmer Dr Sanford

Offutt, Mrs. Vernon Delmus

910 Rountree St Kinston

Ogburn, Mrs. Herbert Hammond

1806 W. Market Greensboro

Ogburn, Mrs. Leon N.

1623 Canterbury Rd Raleigh

Ogburn, Mrs. Lundie Calvin

945 Kenleigh CI Winston-Salem

Oleen, Mrs. George Gerhard, Medlin Rd Monroe

Olive, Mrs. Percy Wingate

1322 Woodland Dr Fayetteville

Oliver, Mrs. Jim Upton

2624 Fairview Rd Raleigh

Oliver, Mrs. Joseph Andrew, Box 458 ....Rockwell

Olson, Mrs. Robert M., P. O. Box 126 Kenly

O'Quinn, Mrs. Edward Nelson

1810 Princess St Wilmington

Ormand, Mrs. John William

309 Lancaster Ave Monroe

Ormond, Mrs. Allison Lee

108 Sixth Ave., N. W Hickory

Outlaw, Mrs. Jackson Kent

808 Pee Dee Ave Albemarle

Owen, Mrs. Duncan Shaw

201 Oakridge Ave Fayetteville

Owen, Mrs. George Franklin, Jr.

120 W. Lynch St Durham

Owen, Mrs. John Fletcher

2631 Fairview Rd Raleigh

Owen, Mrs. William Boyd Waynesville

Owens, Mrs. Francis Leroy Pinehurst

Owens, Mrs. Zack Doxey, Taylor's Beach, Camden
Owsley, Mrs. Lawrence Hayes

Beverly Heights Boone

Pace, Mrs. Charles T., 936 Hill St Greensboro

Pace, Mrs. Karl Busbee, 404 Summit St., Greenville
Pace, Mrs. Samuel Eugene

1617 Market St Wilmington

Packard, Mrs. Douglas Richards

P. O. Box 22 Clinton

Padgett, Mrs. Charles King

Cleveland Springs _ Shelby

432

NORTH CAROLINA MEDICAL JOURNAL

September, I960

Padgett, Mrs. Philip Grover

605 N. Piedmont Ave Kings Mountain

Page, Mrs. Ernest Benjamin, Jr.

2207 Wheeler Rd Raleigh

Page, Mrs. George Dantzler

1855 Cassamia PI Charlotte

Page, Mrs. Harvey A., Kent St Durham

Painter, Mrs. William Watson

920 N. Main St. Mooresville

Palmer, Mrs. Yates Shuford, Louise Rd Vaidese

Palmes, Mrs. Wesley Calhoun, Jr.

440 Ridgeway Ave Statesville

Parham, Mrs. Asa Richmond

1045 Rockford Rd High Point

Parker, Mrs. Charles Council, 114 Warren ..Wilson

Parker, Mrs. John Wesley, Jr. Seaboard

Parker, Mrs. Oscar Lee, 706 College St. .Clinton
Parker, Mrs. Roy Turnage

111 Pinecrest Rd Durham

Parker, Mrs. Samuel Lester, Jr.

1202 Harding Ave Kinston

Parker, Mrs. Shepherd Falkener

Cleveland Springs Shelby

Parker, Mrs. Talbot Fort, Jr.

603 Prince Ave Goldsboro

Parkinson, Mrs. Thomas William

417 Thomas Trail Gastonia

Parks, Mrs. William Craig

Emerywood Estates High Point

Parris, Mrs. Alva E.

1317 Drumcliff Rd Winston-Salem

Parrott, Mrs. Frank Strong

322 Mocksville Ave Salisbury

Parrott, Mrs. John Arendall

2206 Woodview Rd. Kinston

Parsons, Mrs. Lacy Jack, Jr.

2404 Rowland Ave Lumberton

Parsons, Mrs. William Herbert Ellerbe

Paschal, Mrs. George Washington, Jr.

3334 Alamance Dr Raleigh

Paschold, Mrs. John Henry, Park Lane, Albemarle
Pate, Mrs. Archibald Hanes

110 S. Oleander Ave Goldsboro

Pate, Mrs. James Frank, Sr Canton

Pate, Mrs. James Lloyd Fairmont

Pate, Mrs. William Henry Pikeville

Patrick, Mrs. Simmons Isler

2202 Greenbriar Rd Kinston

Patterson, Mrs. Carl Norris

3930 Plymouth Rd., Hope Valley Durham

Patterson, Mrs. F. M. Simmons

1507 Tryon Rd. New Bern

Patterson, Mrs. Fred Geer

511 Senlac Rd Chapel Hill

Patterson, Mrs. Hubert Clifton

Pittsboro Rd. Chapel Hill

Patterson, Mrs. Joseph Flanner, Jr.

Trent Shores New Bern

Patterson, Mrs. Joseph Halford Broadway

Patton, Mrs. John Donald

56 Elk Mtn. Scenic Hwy Asheville

Patton, Mrs. William Hugh, Jr.

Terrace PI Morganton

Payne, Mrs. Clifton G.

1203 Morgan Drive Reidsville

Peak, Mrs. Latham Conrad

409 Lafayette St Clinton

Pearse, Mrs. Richard Lehmer

713 Anderson St Durham

Pearson, Mrs. Hugh Oliver, Box 26 Pinetops

Pearson, Mrs. John Kent, Pearson St Apex

Peck, Mrs. Harold Artemus

425 Dogwood Lane .Southern Pines

Peele, Mrs. James Clarendon

120S Perry Park Dr Kinston

Peeler, Mrs. Forrest Edwards Maiden

Peete, Mrs. Charles Henrv

2027 Woodrow St Durham

Pender, Mrs. John Robert, III

701 Ashworth Rd Charlotte

Penick, Mrs. George Dial

Whitehead Circle Chapel Hill

Pennington, Mrs. Glenn Walton

220 Queens Road East Charlotte

Pennington, Mrs. Luther Thomas

218 Homewood Dr Greensboro

Perreten, Mrs. Frank Arnold

1620 Thorneliffe Rd Winston-Salem

Pen-in, Mrs. Thomas Samuel, Jr.

1761 Sterling Rd Charlotte

Perritt, Mrs. John Olin

1327 Hawthorne Rd Wilmington

Perry, Mrs. David Russell

1120 Eighth St Durham

Perry, Mrs. David Russell, Jr.

746 Sylvan Rd Winston-Salem

Perry, Mrs. Glenn Grey

702 Sunset Dr High Point

Perry, Mrs. Henry Baker, Jr.

208 Homewood Dr Greensboro

Perry, Mrs. Solomon Paul

3602 Rugby Rd., Hope Valley Durham

Perryman, Mrs. Olin Charles, Jr.

3312 Anderson Dr Winston-Salem

Persons, Mrs. Elbert Lapsley

732 Anderson St '. Durham

Peters, Mrs. August Richard, Jr.

Washington Park Washington

Pettus, Mrs. William Henry, Jr.

2051 Cassamia PI Charlotte

Pfeiffer, Mrs. John B., Jr., Rugby Rd Durham

Phelps, Mrs. James Solomon, Jr.

4936 Tewkesbury Rd., Allen Hills Charlotte

Phifer, Mrs. William Houston

Lancaster Rd Monroe

Phillips, Mrs. Charles A. Speas

525 E. Massachusetts Ave Southern Pines

Phillips, Mrs. Charles Kenneth, Box 8, Skyland

Phillips, Mrs. Ernest Nicholas

Finley Park North Wilkesboro

Phillips, Mrs. William Allen

Greenville Sound Wilmington

Pickard, Mrs. Henry Mack

5002 Oleander Dr Wilmington

Pickrell, Mrs. Kenneth L., 3 Sylvan Rd., Durham
Pierce, Mrs. Edwin

824 Chamberlain St Raleigh

Pigford, Mrs. Robert Toms

155 Colonial Dr Wilmington

Pishko, Mrs. Michael Thomas

Midland Rd Pinehurst

Pittman, Mrs. Alfred Roland, Jr.

2304 Rowland Ave Lumberton

Pittman, Mrs. Dorn Carl

Alamance Acres Burlington

Pittman, Mrs. Malory Alfred

Raleigh Rd Wilson

Pittman, Mrs. Raymond Lupton, Sr.

645 Hay St Fayetteville

Pittman, Mrs. William Austin

118 Stedman Ave Fayetteville

Pitts, Mrs. William Reid

429 Eastover Rd Charlotte

Piver, Mrs. James DeCamp

202 E. Bayshore Blvd Jacksonville

Piver, Mrs. William Crawford, Jr.

Washington Park Washington

Pixley, Mrs. Roland Theo

2018 Bucknell Charlotte

Plonk, Mrs. George Webb

Crescent Hill Kings Mountain

Plyler, Mrs. Ralph Johnson

611 Mocksville Ave Salisbury

Podger, Mrs. Kenneth Arthur

217 E. Markham Ave Durham

Pollock, Mrs. Raymond, 509 Middle St., New Bern

September, 1960

ROSTER OF MEMBERS

433

Pool, Mrs. Bennett Baucom

2301 Buena Vista Rd Winston-Salem

Poole, Mrs. Marvin Bailey

500 S. Layton Ave Dunn

Poole, Mrs. Robert Franklin, Jr.

1631 St. Mary's St Raleigh

Pope, Mrs. Henry T.

304 E. 17th St Lumberton

Pope, Mrs. Robert Clyde

404 Monticello Dr ...Wilson

Porter, Mrs. Richard Allison

Haywood Forest Hendersonville

Poteat, Mrs. Hubert McNeill, Jr.

422 Church St Smithfleld

Pott, Mrs. Walter Hawks

102 Lakewood Dr Greenville

Powell, Mrs. Albert Henry

1632 University Dr Durham

Powell, Mrs. Eppie Charles, Jr.

804 E. Park Ave Goldsboro

Powell, Mrs. Jack, 1951 Haywood Rd., Asheville
Powell, Mrs. William Flynn

62 Gertrude PI Asheville

Powers, Mrs. Frank Poydras

2529 White Oak Rd Raleigh

Powers, Mrs. John Alfred

2035 Sherwood Rd Charlotte

Prather, Mrs. Fonzo Goff

131 Cambridge Rd Asheville

Prefontaine, Mrs. Joseph Edouard

901 Dover Rd Greensboro

Presley, Mrs. George Donald Canton

Pressly, Mrs. Claude Lowry

1863 Cassamia PI Charlotte

Pressly, Mrs. David Lowry

576 Dogwood Rd Statesville

Preston, Mrs. John Zennas, Hickorywood, Tryon
Prevatte, Mrs. John Edgar

514 S. First St Smithfield

Prince, Mrs. George Edward

807 Townsend Ave Gastonia

Printz, Mrs. Don Ralph

340 Midland Dr Asheville

Pritchard, Mrs. George Littleton

119 Church St Black Mountain

Pritchett, Mrs. Newton George

1705 St. Mary's St Raleigh

Proctor, Mrs. James Thornton

428 Ridgefield Rd Chapel Hill

Proctor, Mrs. Richard Culpepper

381 Westview Dr Winston-Salem

Pruitt, Mrs. George Calhoun

Lancaster Lane Rockingham

Pugh, Mrs. Charles Harrison

610 S. Lee St Gastonia

Pugh, Mrs. Vernon Watson

1618 Oberlin Rd Raleigh

Pulliam, Mrs. Benjamin Eloth

Robin Hood Rd Winston-Salem

Pumphrey, Mrs. Albert Franklin

Box 627 Elizabethtown

Putney, Mrs. Robert Hubbard, Jr Elm City

Queen, Mrs. Hugh Oscar, Rollins Ave Hamlet

Query, Mrs. Robert Zimri, Jr.

1901 Matheson Ave Charlotte

Quickel, Mrs. John Cephas

1140 S. Edgemont Ave Gastonia

Quinn, Mrs. Clifton Lee LaGrange

Rabil, Mrs. William Edmond

1755 Buena Vista Rd Winston-Salem

Rabold, Mrs. Bernard Louis

Dogwood Hills Newton

Rabold, Mrs. Leonard James

109 W. Newlyn St Greensboro

Raby, Mrs. William Thomas

2121 Bucknell Ave Charlotte

Rachlin, Mrs. Stanton A.

Veteran's Hospital Fayetteville

Radford, Mrs. Howard Lee, 3 Stimson Cliffside

Raiford, Mrs. Fletcher Lindsay

Haywood Forest Hendersonville

Raiford, Mrs. Theodore Sidney

30 Cedarcliff Rd Asheville

Rainev, Mrs. William Thomas, Sr.

140i Ft. Bragg Rd Fayetteville

Ramsaur, Mrs. Jackson Townsend

1011 Fairfield Dr Gastonia

Ramsay, Mrs. James Graham

Washington Park Washington

Ramseur, Mrs. William Lee

405 W. Mountain St Kings Mountain

Raney, Mrs. Richard Beverly

Farrington Rd Chapel Hill

Rankin, Mrs. Pressley Robinson, Jr Ellerbe

Rankin, Mrs. Richard Brandon, Jr.

217 Circle Dr Concord

Rankin, Mrs. Richard Brandon, Sr. ,

33 Marsh St Concord

Rankin, Mrs. Richard Eugene

Mt. Holly-Belmont Rd Mt. Holly

Rankin, Mrs. Rufus Pinkney, Jr.

622 Ashworth Charlotte

Ranson, Mrs. John Lester, Jr.

2819 Glendale Rd Charlotte

Ranson, Mrs. John Lester, Sr.

620 Hermitage Ct Charlotte

Raper, Mrs. James Sidney

24 Cedarcliff Rd Asheville

Rapp, Mrs. Ira Hammes

1922 Beverly Dr Charlotte

Rasberry, Mrs. Edwin Albert, Jr.

200 S. Deans St Wilson

Rasmussen, Mrs. Glenn Steen Kenansville

Rathbun, Mrs. Lewis Standish

46 Forest Rd Asheville

Ravenel, Mrs. Samuel Fitzsimons

106 Fisher Park Circle Greensboro

Ray, Mrs. Frank L.

2021 Dilworth Rd., W Charlotte

Ray, Mrs. Ritz Clyde West Jefferson

Rayle, Mrs. Wiley Wallace Maiden

Redwine, Mrs. O. L. Kenansville

Reece, Mrs. John Cochrane

Riverside Dr Morganton

Reece, Mrs. John David, 206 East North, Albemarle
Reeser, Mrs. Archibald Willard

108 Glovenia St Leaksville

Reeves, Mrs. Jerome Lyda Canton

Reeves, Mrs. Robert James

920 Anderson St Durham

Register, Mrs. John Francis

803 Magnolia St Greensboro

Reid, Mrs. Charles Hamilton, Jr.

770 Oaklawn Ave Winston-Salem

Reid, Mrs. James William Lowell

Reid, Mrs. Ralph Conner Pineville

Reid, Mrs. Robert Learv

646 W. Park Dr Lincolnton

Reid, Mrs. William Joseph

2301 Danbury Rd Greensboro

Reinhardt, Mrs. James Franklin

803 Starmont Dr Durham

Rendleman, Mrs. David Atwell

1015 Holmes St Salisbury

Reynolds, Mrs. Ernest

1231 Richardson Dr Reidsville

Reynolds, Mrs. Frank Russell

1210 Fairway Dr Wilmington

Rhoads, Mrs. John McFarlane

2404 Prince St Durham

Rhodes, Mrs. James Kent

3350 Alamance Dr Raleigh

Rhodes. Mrs. John Sloan

2704 Vand.^rbilt Ave Raleigh

434

NORTH CAROLINA .MEDICAL JOURNAL

September, 19(50

Rhyne, Mrs. Sam AlDertus

632 Greenway Dr Statesville

Ribet, Mrs. James Ernest

State Hospital Morganton

Rice, Mrs. A. Douglas, 1515 Ruffin St Durham

Rice, Mrs. Robert Scott

321 Palaside Dr Concord

Richards, Mrs. Robert D Rock Ridge

Richardson, Mrs. George Irvin

418 Piedmont St Reidsville

Richardson, Mrs. James Justis

Prince St Laurinburg

Richardson, Mrs. William Perry

Box 758 Chapel Hill

Richman, Mrs. Samuel

3903 Madison Ave Greensboro

Riddle, Mrs. Harry Duff

619 W. Hillcrest Ave Gastonia

Ridge, Mrs. Clyde Franklin

609 Colonial Dr High Point

Riggs, Mrs. Millard McAdoo

W. Union St Morganton

Riley, Mrs. William Allen

617 Brent St Winston-Salem

Rippy, Mrs. William Dennis

617 N. Sellars Mill Rd Burlington

Roach, Mrs. Leonard Hunter

25 Sunset Parkway Asheville

Roach, Mrs. Robert Burchell

520 Westview St Lenoir

Robbins, Mrs. Grover Jay

Clinard Road Winston-Salem

Robbins, Mrs. Jack Guyes

1408 Woodborn Rd Durham

Roberson, Mrs. Robert Stuart Hazelvvood

Roberts, Mrs. Bennett Watson

1503 W. Pettigrew St Durham

Roberts, Mrs. Louis Carroll

3920 Plymouth Rd Durham

Roberts, Mrs. Rufus Winston

2727 Canterbury Trail Winston-Salem

Roberts, Mrs. William McKinley

Babington Heights Gastonia

Robertson, Mrs. Carroll Bracey Jackson

Robertson, Mrs. Charles Gurney, Jr.

Country Club Dr Mt. Airy-
Robertson, Mrs. Edwin Mason

1934 Hermitage Ct Durham

Robertson, Mrs. James Mebane Harmony

Robertson, Mrs. John Kenneth Pembroke

Robertson, Mrs. John Newton, Sr.

807 Hay St ...Fayetteville

Robertson, Mrs. Leon Whitfield

401 Shady Circle Dr Rocky Mount

Robertson, Mrs. Lloyd Harvey

4 North Road Salisbury

Robertson, Mrs. Logan Thomas

27 Fairmont Rd Asheville

Robinson, Mrs. Charles Wilson

1114 Belgrave PI Charlotte

Robinson, Mrs. James Elbert

2701 Buena Vista Rd Winston-Salem

Robinson, Mrs. James Thomas, Jr.

1305-D Eaton PI High Point

Robinson, Mrs. Joe

705 McDonald Ave Hamlet

Robinson, Mrs. John Daniel, Box 207 Wallace

Rodman, Mrs. Clark, Riverside Washington

Rodman, Mrs. Olzie Clark

519 W. Main St Washington

Rogers, Mrs. Arthur Merriam

2115 Pinewood CI Charlotte,

Rogers, Mrs. James Rufus

130 Hillsboro St Raleigh

Rogers, Mrs. Malcolm E.

2508 Ramsev St Fayetteville

Rogers, Mrs. Max Pritchard

1112 Rolling Rd High Point

Rogers, Mrs. Seymour Shulman

1503 Alandale Rd Greensboro

Romeo, Mrs. Bruno Joseph

Laurel Park Henderson ville

Romm, Mrs. William Henry

Puddin' Ridge Moyock

Rose, Mrs. Abraham Hewitt, Jr.

723 Lake Boone Trail Raleigh

Rose, Mrs. Abraham Hewitt

543 Hancock St Smithfield

Rose, Mrs. Ira Woodall, Jr.

1319 Canterbury Rd Raleigh

Rose, Mrs. James William Pikeville

Ross, Mrs. Donald MacConnell

418 Fountain PL Burlington

Ross, Mrs. Joseph Alderman

1005 Pee Dee Ave Albemarle

Ross, Mrs. Otho Bescent, Jr.

680 Llewellyn PI Charlotte

Ross, Mrs. Willis Richard

736 E. Oakwood Ave Albemarle

Rosser, Mrs. John Havs, 603 E. Front .. Statesville
Roth, Mrs. O. Ralph

2900 Idlewood Circle Charlotte

Rousseau, Mrs. James Parks

808 Oaklawn Ave Winston-Salem

Rowe, Mrs. Charles Roy, Jr.

633 Margaret Rd Statesville

Royal, Mrs. Benjamin Franklin Morehead City

Royal, Mrs. Donnie Martin

Box 156 Salemburg

Royster, Mrs. Chauncey Lake

2607 Fairview Rd Raleigh

Royster, Mrs. James Dan, Box 68 Benson

Ruark, Mrs. Robert James

3132 Sussex Rd Raleigh

Rubin, Mrs. Adrian Stevens

104 Nutbush Rd Greensboro

Rubin, Mrs. Maurice Harvey

107 Battle Rd Greensboro

Ruffin, Mrs. Julian Meade

816 Anderson St Durham

Rundles, Mrs. Ralph Wavne

132 Pinecrest Rd Durham

Russell, Mrs. Jesse Milton Canton

Russell, Mrs. Phillip Everitt

4 Deerfield Rd Asheville

Russell, Mrs. William Marler

1 Lone Pine Rd Asheville

Ryburn, Mrs. Samuel Benjamin

202 Rowe Ave Wilson

Sadler, Mrs. Ralph Colvert

106 S. Madison St Whiteville

Saleeby, Mrs. Richard George, Jr.

2307 Churchill Rd Raleigh

Salle, Mrs. George Fredric

Isabella Ave Washington

Salter, Mrs. Theodore Beaufort

Saltzman, Mrs. Herbert, 2027 Bivins St., Durham
Sample, Mrs. Robert Cannon

Dana Rd Hendersonville

Sanders, Mrs. Lee Hyman

2502 Anderson Dr Raleigh

Sanger, Mrs. Paul Weldon

1813 Providence Rd Charlotte

Santos, Mrs. Juan J.

212 Pennsylvania Ave Winston-Salem

Sardi, Mrs. Carl Anthony

508 Willowbrook Dr Greensboro

Sargeant, Mrs. Angus Gus

322 Otteray High Point

Sargent, Mrs. Winston Arthur Young' ...Burnsville
Sasser, Mrs. Patrick H., 412 E. Beech ...Goldsboro
Saunders, Mrs. Charles Lawrence, Jr.

Wild wood Lane Burlington

September, 1960

ROSTER OF MEMBERS

435

Saunders, Mrs. John Turner

29 Maywood Rd Asheville

Saunders, Mrs. Stanley Stewart

1322 Greenway Dr High Point

Savage, Mrs. Robert Thomas

133 Revere Rd Winston-Salem

Sawyer, Mrs. Charles Glenn

812 Sylvan Rd Winston-Salem

Sawyer, Mrs. Logan Everett

712 W. Main Elizabeth City

Scarborough, Mrs. Charles Foster, Jr Star

Schafer, Mrs. Earl William

Emerywood Estates High Point

Scherer, Mrs. Irvin George

Box 23 Hampton ville

Schiebel, Mrs. Herman Max

1020 Anderson St Durham

Schlaseman, Mrs. Guy W., Rugby Road ...Durham
Schoenheit, Mrs. Edward William

25 Eastwood Rd Asheville

Schrick, Mrs. Alfred

5630 Riviere Dr Charlotte

Schweizer, Mrs. Donald Conrad

2709 W. Market St Greensboro

Scott, Mrs. Alan Fulton

Mocksville Rd Salisbury

Scott, Mrs. Peter Somers

Route 2 .....Burlington

Scott, Mrs. Samuel Floyd

Route 2 Burlington

Sears, Mrs. Warren Worth

311-A Wakefield Dr Charlotte

Seavy, Mrs. Paul W.

415 Carolina Circle Durham

Seear, Mrs. Torben

938 Paramount Circle Gastonia

Seigman, Mrs. Edwin Lincoln

Box 105 Bunn Dr Rocky Mount

Selbv, Mrs. William Elledge

1126 Belgrave PI Charlotte

Semans, Mrs. James Hustead

1415 Bivins St Durham

Senior, Mrs. Robert Joseph

34 Hayes Rd Chapel Hill

Senter, Mrs. William Jeffress

2330 Churchill Rd Raleigh

Sessions, Mrs. John Turner, Jr.

Morgan Creek Rd Chapel Hill

Setnor, Mrs. Stanford

220 Facility Dr ..Fayetteville

Severn, Mrs. Henry Doeller

4 Pine Tree Rd Asheville

Shackelford, Mrs. Robert Hilliard

201 W. Pollock St Mt. Olive

Shafer, Mrs. Irving Everett, Jr.

618 Margaret Dr Statesville

Shafer, Mrs. Irving Everett, Sr.

230 W. Thomas St Salisbury

Shaffner, Mrs. Louis deS.

818 Sylvan Rd Winston-Salem

Shaia, Mrs. William Harry

2245 Mecklenburg Charlotte

Shannon, Mrs. George Ward

Deweese Ave Rockingham

Sharp, Mrs. William Thomas

Veterans Hospital Salisbury

Sharpe, Mrs. Eugene Baxtev

288 Kenilworth Asheville

Sharpe, Mrs. Frank Alexander

111 E. Hendrix St Greensboro

Shaver, Mrs. William Trantham

1105 Pee Dee Ave Albermarle

Shaw, Mrs. John Alexander

5948 Bragg Blvd Fayetteville

Shaw, Mrs. Llovd Roosevelt

222 N. Oak St Statesville

Shearin, Mrs. W. Thad, Jr.

1163 Carolina Ave., N Carolina Beach

Shelburne, Mrs. Palmer Augustine

2311 Princess Ann St Greensboro

Shelburne, Mrs. Robert C.

159 Lakeshore Dr Asheville

Sheridan, Mrs. Robert John

1020 Tarboro St Rocky Mount

Sherrill, Mrs. Harry B Swansboro

Sherrill, Mrs. John Franklin, Jr.

3326 Rugby Rd., Hope Valley Durham

Shingleton, Mrs. William Warner

3866 Summerset Dr Durham

Shinn, Mrs. George Clyde China Grove

Shipley, Mrs. John LeRoy

309 W. Church Elizabeth City

Shirey, Mrs. John Luther

Leicester Rd., Route 4 Asheville

Shoemaker, Mrs. Carroll Clifton

Route 2 Burlington

Shook, Mrs. Earl Lester, Jr.

37 Gracelyn Rd Asheville

Shuford. Mrs. Jacob Harrison

1007 14th Ave., N. W Hickory

Shull, Mrs. William Henry

2830 Belvedere Ave Charlotte

Sieker, Mrs. Herbert Otto

204 Forestwood Dr Durham

Siewers, Mrs. Christian Fogle

1908 Winterlochen Rd Fayetteville

Sikes, Mrs. Charles Henry

3930 Madison Ave Greensboro

Sikes, Mrs. Walter Allen

State Hospital Raleigh

Silver, Mrs. George A.

3910 Dover Rd Durham

Silverton, Mrs. George

502 W. 26th St Lumberton

Simmons, Mrs. Alexander Wingate

604 Glenwood Ave Burlington

Simons, Mrs. Claude Ernest, Raleigh Rd Wilson

Simpson, Mrs. Henry Hardy

Route 2 Burlington

Simpson, Mrs. Paul Ervin

2612 Dover Rd Raleigh

Simpson, Mrs. Thomas E., Box 327, Walnut Cove
Simpson, Mrs. Thomas William

763 Barnsdale Rd Winston-Salem

Sinclair, Mrs. Carter Ashton

353 8th St., N. W Hickory

Sinclair, Mrs. Louis Gordon

3309 White Oak Rd Raleigh

Sinclair, Mrs. Robey Thomas, Jr.

155 Renovah Circle Wilmington

Singletary, Mrs. George Currie

Box 246 Clarkton

Singletary, Mrs. William Vance

32 Beverly Drive Durham

Sink, Mrs. Charles Shelton

Sunset Dr North Wilkesboro

Sinnett, Mrs. John Franklin

524 W. 8th St. Newton

Siske, Mrs. Grady Cornell Pleasant Garden

Skeen, Mrs. Leo Brown

812 N. Main St Mooresville

Skinner, Mrs. Benjamin Smith

418 S. Duke St. Durham

Slate, Mrs. Francis Wesley, Box 407 Mocksville

Slate, Mrs. John Samuel

1215 W. Fourth St Winston-Salem

Slate, Mrs. Joseph Esmond

1015 Rockford Rd High Point

Slate, Mrs. Marvin Longworth

100 Brantley Circle High Point

Sledge, Mrs. John Burton

507 Forest Lane Charlotte

436

NORTH CAROLINA -MEDICAL JOURNAL

September, 1960

Sloan, Mrs. Allen Barry

745 N. Main St Mooresville

Sloan, Mrs. David Bryan

1116 Magnolia PI Wilmington

Sloan, Mrs. Henry Lee, Jr.

154 Canterbury Dr Charlotte

Sluder, Mrs. Fletcher Sumpter

Chunns Cove Rd Asheville

Sluder, Mrs. Harold Miles

2245 Roswell Ave Charlotte

Smart, Mrs. Gardner Ford

58 St. Dunstans Rd Asheville

Smedberg, Mrs. George Andrew

517 Circle Drive Burlington

Smeltzer, Mrs. Dave Harvev

Route 4, Box 380-K Matthews

Smerznak, Mrs. John Joseph

209 E. Coi-ban St Concord

Smethie, Mrs. William Massie Wadesboro

Smith, Mrs. Albert Goodin

Summerset Dr Durham

Smith, Mrs. Albert Heyward, Jr Waynesville

Smith, Mrs. Anderson Jones Black Creek

Smith, Mrs. Claiborne Thweat

208 Hickory St. Rocky Mount

Smith, Mrs. David Tillerson

3437 Dover Rd Durham

Smith, Mrs. Everette Duane Candler

Smith, Mrs. Franklin Carlton

2219 Radcliffe Ave Charlotte

Smith, Mrs. Harold Benjamin

Finley Park North Wilkesboro

Smith, Mrs. James Jefcoat

1204 E. 3rd St Greenville

Smith, Mrs. James McNeill Rowland

Smith, Mrs. Jay Leland, Jr.

225 N. Rowan Ave Spencer

Smith, Mrs. John Goodrich

200 Wildwood Ave Rocky Mount

Smith, Mrs. Joseph

1303 E. 5th St Greenville

Smith, Mrs. Joseph Pinkney

935 Paramount Circle Gastonia

Smith, Mrs. Opie Norris

107 W. Avondale Greensboro

Smith, Mrs. Roy Meadows

206 Homewood Dr Greensboro

Smith, Mrs. Sidney

905 Williamson' Dr Raleigh

Smith, Mrs. Slade Alvah

308 N. Madison St Whiteville

Smith, Mrs. William Alexander

2310 White Oak Rd Raleigh

Smith, Mrs. William Mitchell

516 Grand Blvd Boone

Snelling, Mrs. John McLucius

1036 Queens Rd., W Charlotte

Snipes, Mrs. Richard Dean

312 Valley Rd Fayetteville

Snow, Mrs. Leo Beman

N. Anderson St Morganton

Sohmer, Mrs. Marcus Frank, Jr.

811 Arbor Rd Winston-Salem

Somers, Mrs. James E.

Sourwood Drive Chapel Hill

Sommerville, Mrs. Lewis Cass

Route 3, Box 1402 West Asheville

Sorrell, Mrs. Furman Yates

Box 221 Wadesboro

Sowers, Mrs. Roy Gerodd

Brinn Drive Sanford

Spaeth, Mrs. Walter

305 Main St Elizabeth City

Sparrow. Mrs. Harry Ward

508 S. Holden Rd Greensboro

Spaugh, Mrs. Earle, 150 McAlway Charlotte

Speas, Mrs. Dallas Cleaborn

2598 Reynolda Rd Winston-Salem

Speas, Mrs. William Paul, Jr.

2519 Country Club Rd Winston-Salem

Speas, Mrs. William Paul, Sr.

437 Springdale Ave Winston-Salem

Spencer, Mrs. Frederick Brunell, Jr.

117 Lilly Ave Salisbury

Spencer, Mrs. Richard Earl

104 Batchelor Dr Greensboro

Spencer, Mrs. William Gear, Jr.

301 West End Ave Wilsoi

Spigner, Mrs. Prescott Bush

1107 Perry St Kinston

Spikes, Mrs. Norman O.

1023 W. Markham Ave Durham

Spillman, Mrs. Louis Cromwell, Jr.

Dodson Mill Rd Pilot Mountain

Sprunt, Mrs. William Hutchinson, Jr.

1931 Virginia Rd Winston-Salem

Sprunt, Mrs. William Hutchinson, in

Morgan Creek Rd Chapel Hill

Spudis, Mrs. Edward Verhines

Apt. 9 Wake Forest College Winston-Salem

Spurr, Mrs. Charles

1845 Buena Vista Rd Winston-Salem

Squires, Mrs. Claude Babbington

2128 Malvern Rd Charlotte

Stanfield, Mrs. Elwin

516 Country Club Dr Fayetteville

Stanfield, Mrs. William Wesley

S. Layton Ave Dunn

Stanley, Mrs. Sherburn Moore Enka

Stallard, Mrs. Sam Kane Reidsville

Stallings, Mrs. T. Lacy

2404 White Oak Rd Raleigh

Starling, Mrs. Howard Montford

123 Pine Valley Rd Winston-Salem

Starling, Mrs. Wyman Plato Roseboro

Stegall, Mrs. John Thomas

327 Oakwood Dr Statesville

Steiger, Mrs. Howard Paul

1927 Sharon Lane Charlotte

Stephen, Mrs. Charles Ronald

1608 University Dr Durham

Stephens, Mrs. Freeman Irby

54 Sunset Parkway Asheville

Stephens, Mrs. Richard Samuel

306 N. Ridge Dr Kannapolis

Stephenson, Mrs. Bennett Edward Rich Square

Sternbergh, Mrs. Waldemar C. A.

1217 Belgrave PI Charlotte

Stevens, Mrs. Hamilton Wright, Jr.

90 Grovewood Rd Asheville

Stewart, Mrs. Albert, Jr.

206 Hinsdale Ave Fayetteville

Stewart, Mrs. Daniel Niven, Jr.

925 4th Ave., N. W Hickory

Stewart, Mrs. Francis Asbury

722 Quarterstaff Rd Winston-Salem

Stewart, Mrs. John Reagan

515 Walnut St Statesville

Stewart, Mrs. Rov Allen

422 W. 9th St Newton

Stiff, Mrs. Audrey Olin

335 Bouchard St Valdese

Stines, Mrs. Ernest Harrison Canton

Stirewalt, Mrs. Neale Summers

703 E. Lexington Ave High Point

Stockdale, Mrs. Wavne Harrop

911 S. Third St Smithfield

Stocker, Mrs. Frederick W.

1124 Forest Hills Blvd Durham

Stockton, Mrs. Irving Richard

919 Tatum Dr New Bern

Stone, Mrs. Leslie Ozburn

922 Sycamore St Rocky Mount

September, 1960

ROSTER OF MEMBERS

437

Stone, Mrs. Marvin Lee

1605 Riviera Dr Rocky Mount

Stoneburner, Mrs. Richard Gresham

595 Parkview Dr Burlington

Stovall, Mrs. Horace Henry

210 Homewood Dr Greensboro

Stratton, Mrs. James David

954 Henley Place Charlotte

Strawcutter, Mrs. Howard Elsworth

1104 N. Chestnut St Lumberton

Street, Mrs. Murdo Eugene, Jr Glendon

Streeter, Mrs. Charles Truman

19 Warlick Street Jacksonville

Stretcher, Mrs. Robert Hatfield Waynesville

Strickland, Mrs. William H.

1009 Fassifern Court Hendersonville

Stringfield, Mrs. James King Waynesville

Stringfield, Mrs. Preston Calvin, Jr.

Finley Park North Wilkesboro

Stringfield, Mrs. Thomas, Jr Waynesville

Strom, Mrs. Carl Henry, 63 Main Sueet, Cliffside
Strong, Mrs. Leonell Clarence, Jr.

263 E. Harper Ave Lenoir

Strong, Mrs. William M.

224 East Boulevard Charlotte

Strosnider, Mrs. Charles Franklin

127 S. John St Goldsboro

Stroupe, Mrs. Albertus Ulla, Jr.

157 Oakland Ave Mount Holly

Stuckey, Mrs. Charles LeGrand

2219 Beverly Dr Charlotte

Stump, Mrs. David J.

1801 Pine View Drive Raleigh

Stvron, Mrs. Charles Woodrow

920 Williamson Dr Raleigh

Sugg, Mrs. William Cunningham

3^5 Roslyn Road Winston-Salem

Suiter, Mrs. Thomas Bavton, Jr.

100 S. Taylor St Rocky Mount

Suiter, Mrs. Wester Ghio

501 Sycamore St Weldon

Summerlin, Mrs. Arthur Rogers

3407 Churchill Rd Raleigh

Summerlin, Mrs. Harry

218 E. Church St Laurinburg

Summerlin, Mrs. Robert L Dublin

Summers, Mrs. John Dent

524 Sixth St., N. W Hickory

Sumner, Mrs. Emmett Ashworth

502 Overbrook Dr High Point

Sutter, Mrs. Renzo Humberto

401 Main St. Mt. Airy

Sutton, Mrs. Edward Colmery

107 Anson Ave Rockingham

Sutton, Mrs. Homer George, Jr.

3700 Reynolda Rd Winston-Salem

Swain, Mrs. Wingate E.

Washington Park Washington

Swann, Mrs. Cecil Collins

21 Browntown Rd Asheville

Sweaney, Mrs. Hunter McGuire

1007 Vickers Ave .Durham

Sweeney, Mrs. C. Leslie, Jr.

301 Northwood Drive Raleigh

Sweeney, Mrs. Edgar Chew

513 Willoughby St Charlotte

Svkes, Mrs. Charles Louis

205 Rawley Ave Mt. Airy

Sykes, Mrs. Ralph Judson

205 Rawley Ave Mt. Airy

Sykes, Mrs. Rufus Preston, Box 428 Asheboro

Takaro, Mrs. Timothy

12 Westchester Dr Asheville

Taliaferro, Mrs. Richard MeCulloch

2311 Lafayette Ave Greensboro

Tally, Mrs. Bailev Thomas

N. Tenth St Albemarle

Tannenbaum, Mrs. Abraham Jack

1301 Latham Rd Greensboro

Tanner, Mrs. Kenneth Spencer, Jr.

611 S. Redgecrest Ave Rutherfordton

Tart, Mrs. James Milton, Jr.

564-A Wakefield Dr Charlotte

Tate, Mrs. Allen Denny, Jr.

415 W. Pine St Graham

Tayloe, Mrs. David Thomas

709 W. Main St Washington

Tayloe, Mrs. John Cotten

Short Drive Washington

Taylor, Mrs. Alistair James

N. C. Sanatorium McCain

Taylor, Mrs. Andrew DuVal

2610 Selwyn Ave Charlotte

Tavlor, Mrs. Frederick Harvev

3642 Park Rd Charlotte

Tavlor, Mrs. Isaac M.

U. N. C. School of Medicine Chapel Hill

Taylor, Mrs. Shahane Richardson

809 Woodland Dr Greensboro

Taylor, Mrs. Thomas Jefferson

614 Franklin St Roanoke Rapids

Taylor, Mrs. Vernon Williams, Jr.

815 N. Bridge St Elkin

Taylor, Mrs. William Ivey, Sr., Box 325 ....Burgaw
Taylor, Mrs. William Ivey, Jr.

Box 156 Wilmington

Temple, Mrs. Rufus Henry

307 Wilson Ave Kinston

Templeton, Mrs. Ralph Gordon

206 W. College Ave Lenoir

Terrell, Mrs. Thomas Eugene

514 Hayworth Circle High Point

Thomas, Mrs. David Pryse

Greenville Sound Wilmington

Thomas, Mrs. James Valentine

149 Highland Drive Leaksville

Thomas, Mrs. Walter Lee

3615 Dover Rd., Hope Valley Durham

Thomas, Mrs. William Ralph

704 Cedar _.._ Elizabeth City

Thompson, Mrs. Alexander Frank, Jr.

118 S. Union St Concord

Thompson, Mrs. Charles Robert

315 Highland Ave Lenoir

Thompson, Mrs. Clive Allen Sparta

Thompson, Mrs. Fred Arrowwood

303 Highland Ave Lenoir

Thompson, Mrs. George Richard Cunliff

2808 Chestnut St Wilmington

Thompson, Mrs. Sanford Webb, Jr Morehead City

Thompson, Mrs. Silas Raymond

240 Cherokee Rd Charlotte

Thompson, Mrs. Winfield Lynn

1304 E. Mulberry Goldsboro

Thorne, Mrs. Edward Young Cox

306 West End Ave Wilson

Thorne, Mrs. Silas Owens, Jr Morehead City

Thornhill, Mrs. Edwin Hale

2828 Lakeview Dr Raleigh

Thornhill, Mrs. George Tudor, Jr.

3021 Granville Dr Raleigh

Thorp, Mrs. Adam Tredwell

543 Avent St Rocky Mount

Thorp, Mrs. Lewis Sumner

1300 W. Thomas St Rocky Mount

Thurmond, Mrs. Jack Alfred

2715 Westfield Rd Charlotte

Thurston, Mrs. Thomas Gardiner

209 S. Ellis Salisbury

Tice, Mrs. Walter Thomas

411 Hillcrest Dr High Point

Tidier. Mrs. James

702 Forest Hills Dr Wilmington

438

NORTH CAROLINA MEDICAL JOURNAL

September, 1960

Timnierman, Mrs. William Bledsoe

1960 Queens Rd., W Charlotte

Todd, Mrs. Lester Claire

1029 Granville Rd Charlotte

Tomlin, Mrs. Edwin Merrill

58 LeCline Dr Concord

Tomlinson, Mrs. Robert Lee

W. Nash Rd Wilson

Townsend, Mrs. William Ball

2200 Pinewood CI. Charlotte

Traehtenberg, Mrs. William

Hillcrest Dr Goldsboro

Trevathan, Mrs. Gordon Earl, Jr.

1908 Forest Hill Dr Greenville

Trivette. Mrs. Parks Dewitt

547 3rd St., N. E Hickory

Troutman, Mrs. Baxter Suttles

511 Mt. View Lenoir

Troxler, Mrs. Eulyss Robert

2314 Princess Ann St Greensboro

Truslow, Mrs. Roy Earl

1708 Penrose Drive Reidsville

Tucker, Mrs. George Franklin Zebulon

Turlington, Mrs. William Troy, Jr.

Woodland Dr Jacksonville

Turrentine, Mrs. Kilby Pairo

809 Rountree St Kinston

Tuttle, Mrs. James Gray

530 N. Fifth St Albemarle

Tuttle, Mrs. Marler Slate

201 Prof. Bldg., Tuttlewood Dr Kannapolis

Tuttle, Mrs. Reuben Gray

784 Stratford Rd Winston-Salem

Tyler, Mrs. Earl Runyon

1524 Hermitage Ct Durham

Tyndall, Mrs. Hubert Durwood

1304 Evergreen Ave Goldsboro

Tyndall, Mrs. Robert Glenn

413 Harding Ave Kinston

Tvner, Mrs. Carl Vann

205 North Patrick Leaksville

Tyner, Mrs. Hugh Edward

Club Drive Gastonia

Tyner, Mrs. Kenneth Vann

363 Springdale Ave Winston-Salem

Tvson, Mrs. Thomas David, Jr.

1106 Ferndale Dr High Point

Tvson, Mrs. Woodrow Wilson

1012 Wellington High Point

Umphlet, Mrs. Thomas Leonard

2519 White Oak Rd Raleigh

Underwood, Mrs. Harry Burnham

125 N. Rice St Statesville

Valk, Mrs. Henrv Lewis

2828 Club Park Rd Winston-Salem

Valone, Mrs. James Austin

1528 Iredell Dr Raleigh

Van Blaricom, Mrs. Lawrence Stickney Naples

Van Doren, Mrs. Peter

Sunset Drive Henderson ville

Van Hoy, Mrs. Joe Milton

2204 Crescent Ave Charlotte

Vann, Mrs. Robert Lee

1928 Virginia Rd Winston-Salem

Vanore, Mrs. Andrew Albert

Box 456 Robbins

Van Velsor, Mrs. Harry

1304 Churchill Dr Wilmington

Vaughan, Mrs. Roland Harris

N. Broad St Edenton

Veazey, Mrs. Alex Halloway

Rhododendron Dr Hendersonville

Verdery, Mrs. William Carey

1428 Raeford Rd Fayetteville

Verdone, Mrs. George Frederick

3800 Wendover CI Charlotte

Verhoef, Mrs. Dirk Huntersville

Verner, Mrs. Hugh David

2300 Westfield Rd Charlotte

Verner, Mrs. John Victor, Jr.

1917 Club Blvd Durham

Vernon, Mrs. James Taylor

120 Woodland Dr Morganton

Vernon, Mrs. James William

209 Valdese Ave Morganton

Vernon, Mrs. William Chester, Jr.

177 Woodland Rd Ashevillo

Vestal, Mrs. Tom A.

1222 Stockton Rd Kinston

Vetter, Mrs. John Stanley

212 Richmond Ave Rockingham

Vinson, Mrs. T. Chalmes Laurel Hill

Vitolo, Mrs. Ralph E.

307 Sherman Dr Fayetteville

Vollmer, Mrs. Donald Henrv

Route 2, Box 300 Ashevillo

Vreeland, Mrs. Walling Douglas, Jr Chadbourn

Wadsworth, Mrs. Harvey B.

515 Broad St New Brrn

Waggoner, Mrs. Lonnie Austin, Jr.

2549 Pinewood Rd G:\stor.h

Walker, Mrs. Archie DuVall, Jr.

Westover Heights E;lenton

Walker, Mrs. Harry Gordon

Route 4 Statesville

Walker, Mrs. John Barrett, Jr.

1222 May Ct Biulir.gton

Walker, Mrs. Samuel Haywood

63 Buchanan Ave Asheville

Walker, Mrs. Thomas English

1200 Greylyn Dr Charlotte

Wall, Mrs. George Ritchie

N. Tenth St Albemarle

Wall, Mrs. Roger Irving

2707 Cambridge Rd ... Raleigh

Wall, Mrs. Roscoe LeGrand, Jr.

822 N. Pine Valley Rd Winston-Salem

Wall, Mrs. William Stanley

1649 Pinecrest Rd Rocky Mount

Wallace, Mrs. John Dixon, Jr.

1019 Woodland Ave Gastonia

Waller, Mrs. Louis Clinton

Route 2, Box 136-A Candler

Walsh, Mrs. Carle Douglas

921 Confederate Ave Salisbury

Walters, Mrs. Hezekiah Grover, Jr.

214 Jefferson St Whiteville

Walton, Mrs. Cyrus Leslie Glen Alpine

Walton, Mrs. James Carey, 125 Maehill Dr., Lenoir
Wannamaksr, Mrs. Edward Jones, Jr.

Route 3, Box 250 Charlotte

Wansker, Mrs. Bernard Arthur

1524 Biltmore Dr Charlotte

Ward, Mrs. Doctor Ernest, Jr.

2206 Barker Lumberton

Ward, Mrs. Ernest

1015 E. Broad St Statesville

Ward, Mrs. Frank Pelouze

1105 Riverside Dr Lumberton

Ward, Mrs. Ivie Alphonso, 211 Church St., Hertford

Ward, Mrs. John Charles LaGrange

Ward, Mrs. Wallace Clyde

1429 Canterbury Rd Raleigh

Ward, Mrs. William Titus

917 Williamson Dr Raleigh

Warren, Mrs. Joseph Benjamin Oriental

Warren, Mrs. Julian Marion Spring Hope

Warren, Mrs. Robert Lee

510 W. Harnett St Dunn

Warrick. Mrs. Luby Albert. Route 1 Goldsboro

Warshauer, Mrs. Albert David

218 Forest Hills Drive Wilmington

Warshauer, Mrs. Samuel Edward

2943 Hydrangea PI Wilmington

September, 1960

ROSTER OF MEMBERS

439

Warwick, Mrs. Hight Claudius

2320 Kirkpatrick PI Greensboro

Washburn, Mrs. Benjamin Earl

219 S. Ridgecrest Ave Rutherfordton

Washburn, Mrs. Willard Wyan Boiling Springs

Wassink, Mrs. William Klein

Route #343 Shiloh

Watkins, Mrs. Carlton Gunter

1223 Marlewood Terrace Charlotte

Watkins, Mrs. William Merritt

1423 Arcadia St Durham

Watson, Mrs. George A.

4023 Bristol Rd Durham

Watson, Mrs. Robert A., Box 487 Elon College

Watters, Mrs. Vernon Gregg, Jr.

204 Rockingham Rd Rockingham

Watts, Mrs. Walter Moore

40 Canterbury Rd Asheville

Way, Mrs. John Edward Beaufort

Way, Mrs. Samuel Eason

625 S. Taylor St Rocky Mount

Wear, Mrs. John Edmund

Country Club Salisbury

Weatherly, Mrs. Carl Holmes

1603 Independence Rd .Greensboro

Weathers, Mrs. Bahnson

928 Monroe St Roanoke Rapids

Weathers, Mrs. Bailey Graham Stanley

Weathers, Mrs. Harry Huntington

401 Roanoke Ave Roanoke Rapids

Weaver, Mrs. Richard Gray

1244 Irving St Winston-Salem

Webb, Mrs. Alexander, Jr.

1019 Cowper Dr Raleigh

Weeks, Mrs. John Francis

Winslow Acres Elizabeth City

Weeks, Mrs. Kenneth Durham

1014 West Haven Blvd Rocky Mount

Weinel, Mrs. William Harvey

4014 Evergreen Road Wilmington

Welfare, Mrs. Charles Randall

2641 Reynolda Rd Winston-Salem

Wellborn, Mrs. William Revere, Jr.

300 Avery Ave Morganton

Wells, Mrs. Edwin Julius

2802 Oleander Drive Wilmington

Wells, Mrs. Marius Hughey

923 Haywood Rd. Asheville

Welton, Mrs. David Goe

1900 Beverly Dr Charlotte

Wentz, Mrs. Irl Jesse

1721 Colony Rd Salisbury

Wessell, Mrs. John Charles

1501 Market St Wilmington

West, Mrs. Bryan Clinton

Perrv Park Dr Kinston

West, Mrs. Clifton Forest

Perry Park Dr Kinston

Wester, Mrs. Thaddeus Bryan

508 W. 28th Lumberton

Westmoreland, Mrs. Joseph Robert Canton

Weyher, Mrs. John E., Jr.

Overbrook Drive Goldsboro

Whalev, Mrs. James Davant

605 Third Ave., N. W Hickory

Wharton, Mrs. Charles Watson

201 Meadowbrook Smithfield

Whicker, Mrs. Guy Lorraine

Route 1, Box 20 Kannapolis

Whicker, Mrs. Max Evans

504 S. Franklin St China Grove

Whisnant, Mrs. Albert Miller

Park Rd., Route 2 Charlotte

Whitaker, Mrs. Donald Nash

1425 Canterbury Rd Raleigh

Whitaker. Mrs. James Allen

624 Falls Rd Rocky Mount

Whitaker, Mrs. Paul F.

1205 N. Queen St Kinston

Whitaker, Mrs. Richard Harper

120 N. Cherry St Kernersville

White, Mrs. Edward Russel, Jr.

2634 Reynolda Rd Winston-Salem

White, Mrs. James Stark

1807 Efland Dr Greensboro

White, Mrs. Philip Fleteher

Stanley Ave Rockingham

White, Mrs. Thomas Preston

714 N. Edgehill Rd Charlotte

White, Mrs. William Elliott

3936 Churchill Rd Charlotte

Whitehead, Mrs. Seba Loren

341 Vanderbilt Rd Asheville

Whitener, Mrs. Donald Leonard

433 Lynn Ave Winston-Salem

Whitesides, Mrs. Edward Steele

215 N. Highland St Gastonia

Whitesides, Mrs. William Carl, Jr.

1500 Coventry Rd Charlotte

Whitley, Mrs. Joseph E.

Twin Castle Apt.s Winston-Salem

Whitley, Mrs. Robert Macon, Jr.

Country Club Dr Rocky Mount

Whitt, Mrs. Walter Fuller, Jr.

206 Charleston Monroe

Whittington, Mrs. Claude Thomas

600 Country Club Dr Greensboro

Wiggins, Mrs. John Carroll, Jr.

785 Arbor Rd Winston-Salem

Wilder, Mrs. Roboteau Terrell

Rotary Drive High Point

Wilkerson, Mrs. Charles Baynes, Sr.

517 N. Wilmington St Raleigh

Wilkerson, Mrs. Charles Baynes, Jr.

2113 Woodland Ave Raleigh

Wilkerson, Mrs. Louis Reams

2301 Dixie Trail Raleigh

Wilkins, Mrs. Kenneth Worth

102 S. Pineview Ave Goldsboro

Wilkins, Mrs. Robert Bruce

1007 Minerva Ave Durham

Wilkinson, Mrs. Charles Tolbert

521 S. Main St Wake Forest

Wilkinson, Mrs. James Spencer

3029 Granville Dr Raleigh

Wilkinson, Mrs. Louis Lee

1033 Rockford Rd High Point

Wilkinson, Mrs. Robert Watson, Jr.

513 S. Main St Wake Forest

Will, Mrs. Thomas Augustine

207 N. Hoffman St Dallas

Willett, Mrs. Robert Walter

Galax Dr., Route 6 Raleigh

Williams, Mrs. Charles David, Jr.

536 Seneca Place Charlotte

Williams, Mrs. Charles Frederick

3203 White Oak Rd Raleigh

Williams, Mrs. Edward Jerome

30] Lancaster Monroe

Williams, Mrs. Ernest Council

1008 Edgewood Circle Gastonia

Williams, Mrs. Jerome Otis

105 Country Club Dr Concord

Williams, Mrs. Kenan Banks

747 Oaklawn Ave Winston-Salem

Williams, Mrs. Leonidas Polk

300 S. Granville St Edenton

Williams, Mrs. McChord

3954 Churchill Rd Charlotte

Williams, Mrs. Ralph Bertram, Jr.

714 Forest Hills Dr Wilmington

Williams, Mrs. Robert

2305 Hathaway Rd Raleigh

4-10

NORTH CAROLINA MEDICAL JOURNAL

September, 1960

Williams, Mrs. Robert Weser

727 Windsor Dr Wilmington

Williams, Mrs. Roderick Thomas Farmville

Williams, Mrs. Samuel Clay

201 Westview Dr Winston-Salem

Williams, Mrs. Samuel Hodges, Jr.

Old Bath Highway Washington

Williams, Mrs. Thomas Franklin

Whitehead Circle Chapel Hill

Williams, Mrs. Thomas Richard, Jr.

25 9th Ave., N. E Hickory

Williams, Mrs. Trevor George

Morgan St Forest City

Williford, Mrs. John Kenneth

1211 11th St Lillington

Willis, Mrs. Candler Arthur

Route 2 Candler

Willis, Mrs. Harrv Clay

906 W. Vance St Wilson

Willis, Mrs. Tom Vann Sparta

Wilsey, Mrs. John Derrick, III

Reynolda Estates Winston-Salem

Wilson, Mrs. Clarence Lafayette

212 N. Main St Lenoir

Wilson, Mrs. Frank

2317 Hathaway Rd Raleigh

Wilson, Mrs. Franklin LeRoy

1908 Sharon Rd Charlotte

Wilson, Mrs. Hadley McDee

117 Woodland Dr Boone

Wilson, Mrs. James Stepheson

1501 Washington St Durham

Wilson, Mrs. John Knox

1008 Dover Rd Greensboro

Wilson, Mrs. Leonard Livingston

301 Brentwood Ava Jacksonville

Wilson, Mrs. Samuel Allen

710 E. Park Dr Lincolnton

Wilson, Mrs. Thomas Barnette

3328 White Oak Rd Raleigh

Wilson, Mrs. Virgil Archibald

2340 Cherokee Lane WTinston-Salem

Wilson, Mrs. Walter Howard

2017 St. Mary's St Raleigh

Winkler, Mrs. Harry

239 Ferncliff Rd Charlotte

Winstead, Mrs. John Lindsay

302 Greene St Greenville

Wise, Mrs. Fred Eugene, Jr.

1509 Maryland Ave Charlotte

Witherington, Mrs. Dexter T.

414 Mitchell St Kinston

Withers, Mrs. Syndor Terry

701 W. Vernon Ave Kinston

Withers, Mrs. William Alphonso

2403 Country Club Dr Raleigh

Witten, Mrs. Ernest Robert Sidnev

80 Wembly Rd Asheville

Wolfe, Mrs. Harold Eugene

300 S. Andrews Ave Goldsboro

Wolfe, Mrs. Hugh Claibourne

108 Beverly Place Greensboro

Wolfe, Mrs. Ralph Verlon

440 N. Hawthorne Rd Winston-Salem

Wolff, Mrs. Dennis Roscoe

Cannon Court Apts Greensboro

Wolff, Mrs. George Thomas

805 Magnolia St Greensboro

Womack, Sirs. Nathan Anthony

Route 2 Chapel Hill

Womble, Mrs. Edwin Cornelius Wagram

Womble, Mrs. William H.. Jr.

Westridge Rd., Route 9 Greensboro

Wood, Mrs. Ernest Harvev. Jr.

1004 Pittsboro Rd Chapel Hill

Wood, Mrs. Frank

115 W. King St Edenton

Wood, Mrs. George Thomas, Jr.

Route 1 High Point

Wood, Mrs. Hagan Emmett

W. N. C. Sanatorium Black Mountain

Wood, Mrs. Sherrod Newberry Enfield

Wood, Mrs. William Lupton, Sr.

Box 278 Yadkinville

Wood, Mrs. William Reed

204 Rockford Rd Greensboro

Woodard, Mrs. Marshall Wayne

145 Midland Dr Asheville

Woodhall, Mrs. Maurice Barnes

4006 Dover Rd., Hope Valley Durham

Woodruff, Mrs. Fred Gwyn

606 Hillcrest Dr High Point

Woodruff, Mrs. Paden Eskew

1732 Brenner Ave Salisbury

Wooten, Mrs. Cecil William, Jr.

1101 Rhem St Kinston

Wooten, Mrs. Floyd Pugh

1114 W. College St Kinston

Wooten, Mrs. John Lemuel

109 S. Harding St Greenville

Wooten, Mrs. William Isler

Maple St Greenville

Worde, Mrs. Boyd T., 504 Carver St Durham

Worden, Mrs. Neil Ashton Hope Mills

Worth, Mrs. Thomas Clarkson

500 Lake Boone Trail Raleigh

Wray, Mrs. James Bailey

600 Windemere Circle Winston-Salem

Wrenn, Mrs. Richard Nickles

1432 Ferncliff Rd Charlotte

Wright, Mrs. Charles Newbold Jarvisburg

Wright, Mrs. Frederick Starr

933 Hendersonville Rd Asheville

Wright, Mrs. Isaac Clark

329 Transylvania Ave Raleigh

Wright, Mrs. James Rhodes

3319 White Oak Rd Raleigh

Wright, Mrs. James Thurman Belhaven

Wright, Mrs. John Joseph

Box 1267 Chapel Hill

Wright, Mrs. Richard Brandon, Jr.

Country Club Salisbury

Wright, Mrs. Samuel Martin

2003 Morganton Rd Fayetteville

Wright, Mrs. Thomas Hasel, Jr.

555 Hempstead PI Charlotte

Wright, Mrs. William David

1222 Grayland St Greensboro

Wyche, Mrs. Joseph Thomas

Baldwin Woods Whiteville

Wvlie, Mrs. William DeKalb

310 Arbor Rd Winston-Salem

Wvngarden, Mrs. James B.

1104 Knox St Durham

Yelton, Mrs. Ernest Hugh

Tryon Rd Rutherford ton

Yeomans, Mrs. Merrill Brooks

403 Gold St Shelby

Young, Mrs. Charles Gibson

306 Kirk Road Greensboro

Young, Mrs. David Alexander

1546 Iredell Dr Raleigh

Young, Mrs. Joseph Alexander

S. College Ave Newton

Young, Mrs. Robert Foster Roanoke Rapids

Young, Mrs. William Beauregard

306 Kincaid Ave Wilson

Young, Mrs. William Glenn

1407 Dollar Ave Durham

Youngblood, Mrs. Vernon Hinson

20 Winecoff Blvd Concord

Yount, Mrs. Ernest Harshaw, Jr.

2800 Greenwich Rd Winston-Salem

Zankel, Mrs. Harrv Tevel

123 Newell St Durham

Zealy, Mrs. Albert Hazel, Jr.

206 N. James Goldsboro

Zeppa, Mrs. Robert, 206 Hill St Chapel Hill

September, 1960

ADVERTISEMENTS

XXXIX

Iii Acute
Illness . . .

NILEVAE*

Can Speed
Recovery

Commonly, negative nitrogen balance1 occurs
during acute febrile illnesses and following
traumatic events and surgical procedures." As
much as 300 to 400 Gm. of nitrogen2 may be
destroyed daily in severe infections. Convales-
cence1 is delayed when negative nitrogen bal-
ance is large and persistent.

NILEVAR Builds Protein, Speeds Convales-
cence to Complete Recovery3 6 ". . . we were
impressed3 with the efficacy of Nilevar as an
anabolic agent. All of the patients reported feel-
ing much more vigorous and experiencing an
increase in appetite. . . ."

The actions of Nilevar4 in reversing a nega-
tive nitrogen balance — and therefore a negative
protein balance— improving the appetite and in-
creasing the sense of well-being can be expected
to shorten the illness and the convalescence of
these patients.

An initial daily dosage of 30 mg. of Nilevar
(brand of norethandrolone) is suggested. After
one to two weeks, this dosage may be reduced
to 10 or 20 mg. daily in accordance with the re-
sponse of the patient. Continuous courses of
therapy should not exceed three months, but
may be repeated after rest periods of one
month. Nilevar is supplied as tablets of 10 mg.,
drops of 0.25 mg. per drop and ampuls of 25
mg. in 1 cc. of sesame oil with benzyl alcohol.

I. Eisen, H. N., and Tobachnick, M.: Protein Metabolism, M.
Clin. North America 39:863 (May) 1955. 2. Jamison, R. M.
General Nutritive Deficiency, Virginia M. Month. 83:67 (Feb.
1956. 3. Goldfarb, A. f .; Napp, E. E.; Stone, M. L; Zucker
man, M. B., and Simon, J.: The Anabolic Effects of Norelhan
drolone, a 1 9-Nortestosterone Derivative, Obst. & Gynec
11.454 (April) 1958. 4. Batson, R.: Investigators Report, Feb

II, 1956. 5. Weston, R. E.; Isaacs, M. C; Rosenblum, R.
Gibbons, D. M., and Grossman, J.: Metabolic Effects of at
Anabolic Steroid, 17-Alpha-Ethyl-l 7-Hydroxy-Norandrostenone
in Human Subjects, J. Clin. Invest. 35.-744 (June] 1956. 6. Brown
C. H.: The Treatment of Acute and Chronic Ulcerative Colitis
Am. Pract. & Digest Treat. 9.405 (March) 1958.

e. d. SEARLE&co.

CHICAGO 80, ILLINOIS

Research in the Service of Medicine

XL

NORTH CAROLINA MEDICAL JOURNAL

September, 19(10

preventable tragedy:

permanent pitting and scarring in acne

in acne vulgaris: //((j

for effective control of the pyogenic organisms

often responsible for permanent pitted and hypertrophic scars1

I

®

AT. no. 2,791,60fl

capsules

The Original Tetracycline Phosphate Comple*

broad spectrum efficacy with unmatched record of safety and tolerance

Supply: TETREX Capsules— tetracycline phosphate
complex — each equivalent to 250 mg, tetracycline
HCI activity. Bottles of 16 and 100. Capsules-100
mg. — bottles of 25 and 100. Information on conven-
ient dosage schedule available on request

1. Rein, C. R., and Fleischmajer, R.: The efficacy of tetra-
cycline phosphate complex (TETREX) in dermatological
therapy. Antibiotic Med. &. Clin. Ther. 4:422 (July) 1957.

BRISTOL LABORATORIES
SYRACUSE, NEW YORK

September, 1960

ADVERTISEMENTS

XLI

Fair

Change

Rain

Stormy

•

: '■ :

"the G-I tract
is the
barometer
of the mind..."

Belbarb

soothes the agitated mind

and calms the G-I spasm

through the central effect

of phenobarbital and the

synergistic action of

fixed proportions

of natural belladonna

alkaloids on the

gastrointestinal tract.

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BELBARB

SEDATIVE ANTISPASMODIC

20 years of clinical satisfaction
Belbarb No. 1; Belbarb No. 2; Belbarb Elixir; Belbarb-B

CHARLES C.<

HASKELL

►& COMPANY, Richmond, Virginia

XLII

NORTH CAROLINA MEDICAL JOURNAL

September, l!ii>0

Just one prescription for tLngran Term-Pak

SOuiaBVITAMl».»INtB*L5UfPlEH£NT (270 tMetS)

calling for just one tablet per day will carry her
through term to the six-week postpartum check-
up.Thus, you help to assure a nutritionally perfect
pregnancy, while providing the convenience and
economy of the re-usable Term-Pak. \X££5[

Engran is also available
100 tablets.

SQUIBB

Squibb Quality — The Priceless Ingredient

ENQRAN' And 'TERM-PAK" ARE SQUIBB TRADEMARKS

September, 1960

ADVERTISEMENTS

XLIII

XLIV

NORTH CAROLINA MEDICAL JOURNAL

September, 1'JfiO

Sep

taken at bedtime

BONADOXIjN

STOPS MORNING SICKNESS IN 94% ' ^*

OFTEN WITH JUST
ONE TABLET DAILY

by treating the symptom-
nausea and vomiting— as well
as a possible specific cause —
pyridoxine deficiency

each tiny Bonadoxin
tablet contains:
Meclizine HC1 (25 mg.)
for antinauseant action
Pyridoxine HC1 (50 mg.)
for metabolic replacement.

usual dose: One tablet at
bedtime; severe cases may require
another tablet on arising.

supply: Bottles of 25 and
100 tablets. Bonadoxin also
effectively relieves nausea and
vomiting associated with:
anesthesia, radiation sickness,
Meniere's syndrome, labyrinthitis,
and motion sickness. Also useful in
postoperative nausea and vomiting.

Bibliography on request.

For infant colic, try
Bonadoxin Drops. Each cc.
contains: Meclizine 8.33 mg./
Pyridoxine 16.67 mg.

New York 17, N. Y.

Division, Chas. Pfizer & Co., Inc.

Science for the World's Well-Being'"^

and . . . when your OB patient needs the best
in prenatal vitamin-mineral supplementation .

OBRON®

September, 1960

ADVERTISEMENTS

XLV

whenever depression
complicates the picture

In many seemingly mild physical disorders
an element of depression plays an
insidious etiologic or complicating role.

Because of its efficacy as an antidepres-
sant, coupled with its simplicity of usage,
Tofranil is admirably adapted to use in the
home or office in these milder "depression-
complicated" cases.

Tofranil

brand of imipramine HCI

hastens recovery

Geigy

It is always wise to recognize that depres-
sion may be an underlying factor. ..that
Tofranil may speed recovery in "hypochon-
driasis"; in convalescence when recovery
is inexplicably prolonged; in chronic illness
with dejection; in the menopausal patient
whose emotional disturbances resist
hormone therapy; and in many other com-
parable situations in which latent depres-
sion may play a part.

Detailed Literature Available on Request.

Tofranil", brand of imipramine hydrochloride,
tablets of 25 mg. Ampuls for intramuscular
administration, 25 mg. in 2 cc. of solution.

160-60

Geigy, Ardsley, New York

XLVI

NORTH CAROLINA MEDICAL JOURNAI

September, 1000

no irritating crystals • uniform concentration in each drop
STERILE OPHTHALMIC SOLUTION

NEO-HYDELTRASOL

2,000 TIMES MORE SOLUBLE THAN

"The solution of prednisolone has the

advantage over the suspension in that no

crystalline residue is left in the patient's

cul-de-sac or in his lashes .... The other

advantage is that the patient does not have to

shake the drops and is therefore sure of

receiving a consistent dosage in each drop."2

PREDNISOLONE 21 PHOSPHATE -NEOMYCIN SULFATE

PREDNISOLONE OR HYDROCORTISONE

1. Lippmann. 0 .. Arch Ophth. 57:339. March 1957

2. Gordon, D.M.. Am J, Ophth, 46:740, November 1958.
supplier): 0.5% Sterile Ophthalmic Solution NEO-
HYDELTRASOL (with neomycin sulfate) and 0.5% Sterile
Ophthalmic Solution HYDELTRASOL'. In 5 cc. and 2.5 cc
dropper vials. Also available as 0.25% Ophthalmic
Ointment NEO-HYDELTRASOL (with neomycin sulfate)
and 0.25% Ophthalmic Ointment HYDELTRASOL.
In 3.5 Gm tubes.

HYDELTRASOL and NEO-HYDELTRASOL are trademarks of Merck S, Co.. Inc.
i^ MERCK SHARP & DOHME Division of Merck S Co . Inc.. Philadelphia 1. Pa

September, 1960

ADVERTISEMENTS

XLVII

Don't settle for
slow-power" x-ray

/

,-*

V ^-^J

■'4'

T

at <tM

<d

get a full 200-ma with your Patrician combination

When anatomical motion threatens to blur ra-
diographs, the 200-ma Patrician can answer
with extreme exposure speed, twice that of any
100-ma installation. Film images show im-
proved diagnostic readability . . . retakes are
fewer. And you'll find the G-E Patrician is like
this in everything for radiography and fluoro-
scopy: built right, priced sensibly, uncompro-
mising in assuring you all basic professional
advantages. Full-size 81" table . . . independ-
ent tubestand . . . shutter limiting device . . .
automatic tube protection . . . counterbalanced
fluoroscope, x-ray tube and Bucky . . . full-
wave x-ray output.

You also can rent the Patrician —

through G-E Maxiservice® x-ray rental plan.
Gives you the complete x-ray unit, plus main-
tenance, parts, tubes, insurance, local taxes —
everything — for one, uniform monthly fee. Get
details from your local G-E x-ray representa-
tive listed below.

_■

. .... ..

i

^.ii^-^^^i

^K

1

JL

9

Jbl

v

Bfel '

\ jHB

il

<Z9m-

Progress Is Our Most Important 'Product

GENERAL ^ ELECTRIC

Direct Factory Branch
CHARLOTTE

1140 Elizabeth Ave.
FR 6-1531

NORTH CAROLINA

Resident Representatives
WILSON

A. L. Harvey

1501 Branch St. • Phone 23 7-2440

WINSTON-SALEM

N. E. Bolick
1218 Miller St. • Phone PArk 4-5864

XLVIII

NORTH CAROLINA MEDICAL JOURNAL

September, I960

I

>

kOO

O^

Now... the only

Nystatin combination

with extra-active

DECLOMYCIN

D

Demethylchlortetracycline

with extra-broad spectrum benefits:—
action at lower milligram intake... broad-
range action... sustained peak activity...
extra-day security against resurgence of
primary infection or secondary invasion.

ECLOSTATIN@

Demethylchlortetracycline and Nystatin LEDERLE

CAPSULES, 150 mff. DECLOMYCIN Demethylchlortetracycline HCl and 250,000 units Nystatin.

dosage: average adult, 1 capsule four times daily.

LEDERLE LABORATORIES, A Division of AMERICAN CYANAMID COMPANY, Pearl River, New York

September, 1960

ADVERTISEMENTS

XLIX

'B.W. & Co/ 'SporiiT Ointments

rarely sensitize . . .
give decisive bactericidal action
for most every topical indication

'CORTISPORIN'

® Broad-spectrum antibac-
terial action— plus the
soothing anti-inflam-
matory, antipruritic ben-
efits of hydrocortisone.

-/

'POLYSPORIN'

brand Antibiotic Ointment

basic antibiotic com-
bination with proven
effectiveness for the
topical control of gram-
positive and gram-nega-
tive organisms.

Contents per Gm.

'Polysporin'®

'Neosporin'®

'Cortisporin'®

'Aerosporin'® brand
Polymyxin B Sulfate

10,000 Units

5,000 Units

5,000 Units

Zinc Bacitracin

500 Units

400 Units

400 Units

Neomycin Sulfate

—

5 mg.

5 mg.

Hydrocortisone

—

—

10 mg.

Supplied:

Tubes of 1 oz.,

>/2 oz. and '/8 oz.

(with ophthalmic tip)

Tubes of 1 oz.#

'/2 oz. and '/a oz.

(with ophthalmic tip)

Tubes of Vi oz. and

Vs oz. (with

ophthalmic tip)

BURROUGHS WELLCOME & CO. (U.S.A.) INC., Tuckahoe, New York

'ORTH CAROLINA MEDICAL JOURNAL

September, 19(50

Diagnostic

Quandaries

Colitis? Gall Bladder Disease?

Chronic Appendicitis?

Rheumatoid Arthritis? Regional Enteritis?

I DISEASE that is frequently
■ i v overlooked in solving diag-
I nostic quandaries is amebiasis.
BBBH Its symptoms are varied and
contradictory, and diagnosis is extremely
difficult. In one study, 561 of the cases
would have been overlooked if the routine
three stool specimens had been relied on.1

Another study found 961 of a group
of 150 patients with rheumatoid arthritis
were infected by E. histolytica. In 15 of
these subjects, nine stool specimens were
required to establish the diagnosis.-

Webster discovered amebic infection in
147 cases with prior diagnoses of spastic
colon, psychoneurosis, gall bladder dis-
ease, nervous indigestion, chronic appen-
dicitis, and other diseases. Duration of
symptoms varied from one week to over
30 years. In some cases, it took as many
as six stool specimens to establish the
diagnosis of amebiasis.3

Now treatment with Glarubin provides
a means of differential diagnosis in sus-
pected cases of amebiasis. Glarubin, a
crystalline glycoside obtained from the
fruit of Simarouba glauca, is a safe, effec-
tive amebicide. It contains no arsenic,
bismuth, or iodine. Its virtual freedom
from toxicity makes it practical to treat

suspected cases without undertaking dif-
ficult, and frequently undependable, stool
analyses. Marked improvement following
administration of Glarubin indicates path-
ologically significant amebic infection.

Glarubin is administered orally in tablet
form and does not require strict medical
supervision or hospitalization. Extensive
clinical trials prove it highly effective in
intestinal amebiasis.

*

Glarubin

TABLETS

specific for intestinal amebiasis

Supplied in bottles of 40 tablets, each
tablet containing 50 mg. of glaucarubin

Write for descriptive literature, bibli-
ography, and dosage schedules.

1. Cook. J.E.. Briccs. G.W., and Hindlcy. F.W.: Chronic Ame-
biasis and the Need for a Diagnostic Profile, Am Pract. and D1R
or Treat. e:is2i (Dec, 1955

2. Rinehart. RE, and Marcus. H : Incidence of Amebiasis in
Healthy Individuals. Clinic Patients and Those with Rheumatoid
Arthritis. Northwest Med . 54:708 ijuly, 1955).

■i. Webster, B II : Amebiasis, a Disease nf Multiple Manifesta-
tions. Am. Pract. and Dig. of Treat. 5:S!'7 (June. 1958).

•U.S. Pat. Xo. 2.S64.745

THE S.E. |y|ASSENGILL COMPANY

NEW YORK

BRISTOL, TENNESSEE
KANSAS CITY

SAN FRANCISCO

September, 1960

ADVERTISEMENTS

LI

for control of nasal allergies

and seasonal hay fever

BRAND OF TIMED DISINTEGRATING ANTIHISTAMINE-DECONGESTANT TABLETS

Each tablet contains:

6.0 mg. Chlorpheniramine Maleate

37.5 mg. Pyrilamine Maleate

15.0 mg. Phenylephrine
Hydrochloride

ONE TABLET

swiftly drys up nasal secretions;

yields maximum response 10 to 12 hours

1

One third of the dosage disintegrates
immediately to control irritating nasal
secretions. The remaining dosage re-
leases gradually to provide a therapeu-
tic effect up to 10 to 12 hours. Only
minimum side effects and low pressor.

Two widely proven antihistamines.
And, a potent decongestant. Now
combined in Animine Timed Disinte-
grating Tablets.

Anamine

Available in bottles
50 and 250 tablets;
also pint liquid.

Mayrand

inc.

PHARMACEUTICALS

Greensboro, North Carolina

LI I

NORTH CAROLINA MEDICAL JOURNAL

September. 1960

AN AMES CLINIQUICK

CLINICAL BRIEFS FOR MODERN PRACTICE

■

WHAT

LABORATORY

PROCEDURES

ARE INDICATED IN

DIABETICS WITH

URINARY TRACT

INFECTIONS? a

A urine culture is absolutely essential in the diabetic suspected of having a urinary tract infec-
tion since such infection is not always accompanied by pyuria. It is also essential to keep the
urine free from sugar — as shown by frequent urine-sugar tests— for successful therapy.

Source: Harrison, T. R., et at.: Principles of Internal Medicine, ed. 3, New York, McGraw-Hill Book Co., 1958, p. 610.

the most effective method of routine testing for glycosuria . . .
color-calibrated

c

!■*

yy d

<""•"> Reagent Tablets

the standardized urine-sugar test for reliable quantitative estimations

Urinary tract infections are about four times more frequent in the diabetic than in
the non-diabetic. The prevention and treatment of urinary tract infections, as well as
the avoidance of other complications of diabetes, are significantly more effective in the
well-controlled diabetic. The patient should be impressed repeatedly with the importance
of continued daily urine-sugar testing— especially during intercurrent illness— and warned
of the consequences of relaxed vigilance.

"urine-SUgar profile" With the new Graphic Analysis Record included in the Clinitest

Urine-Sugar Analysis Set (and in the tablet refills), daily urine-sugar readings may be recorded to
form a graphic portrayal of glucose excretion most useful in clinical control. ^^^^^e^eo

• motivates patient cooperation through everyday use of Analysis Record

• reveals at a glance day-to-day trends and degree of control MIVI tO

• provides a standardized color scale with a complete range in the familiar blue-to company, inc

„ Elkhart • Indiana

orange spectrum

Toronto • Canodo

guard against ketoacidosis

...test for ketonuria

for patient and physician use

ADDED SAFETY FOR DIABETIC CHILDREN

ACETESF KET0STIX@

Reagent Tablets Reagent Strips

September, 1960

ADVERTISEMENTS

LIII

Because the active ingredients of a spermicidal prepara-
tion must diffuse rapidly into the seminal clot and
throughout the vaginal canal to be clinically effective.

Lanesta Gel offers this dual protection. Its four
spermicidal agents quickly invade the clot to stop the
main body of sperm. It spreads evenly and quickly
throughout the vaginal canal— seeks out every wrinkle
and fold that may offer concealment to sperm. With
this rapid diffusion, your patient receives full benefit
of the swift spermicidal action of Lanesta Gel — in
minutes — a decisive measure in conception control.

In Lanesta Gel 7 ' -cbloro-4-indanol, a new, effective,
nonirritating, nonallergenic spermicide, produces im-
mediate immobilization of spermatozoa in dilution

of up to 1 :4,000. The addition of 10 per cent NaCl in
ionic form greatly accelerates spermicidal action. Ri-
cinoleic acid facilitates rapid inactivation and immo-
bilization of spermatozoa and sodium lauryl sulfate
acts as a dispersing agent and spermicidal detergent.

Lanesta Gel with a diaphragm provides one of the
most effective means of conception control.
However, whether used with or without a
diaphragm, the patient and you, doctor, can
be certain that Lanesta Gel provides faster
spermicidal action — plus essential diffusion
and retention of the spermicidal agents in
a position where they can act upon the
spermatozoa.

sta G e I

Supplied: Lanesta Exquiset® . . . with diaphragm of prescribed size and type; universal introducer;

Lanesta Gel, 3 oz. tube, with easy clean applicator, in an attractive purse. Lanesta Gel, 3 oz. tube with A pTOfJUCt

applicator; 3 oz. refill tube — available at all pharmacies. gf l_3nt66n®

research.

Manufactured by Esca Medical Laboratories. Inc , Alliance, Ohio. Distributed by George A. BREON & Co.. New York 18, N. Y.

LIV

XORTH CAROLINA MEDICAL JOURNAL

September, 19'iO

Now —All cold symptoms
can be controlled

Tussagesic

timed-release C — s tablets

Controls congestion

with Triaminic,1-23 the leading oral

nasal decongestant.

Controls aches and fever
with well-tolerated APAP, non-addic-
tive analgetic4 and excellent antipyretic.5

Each TUSSAGESIC Tablet provides:

TRIAMINIC* 50 mg.

(phenylpropanolamine HC1 25 mg.

pheniramine maleate 12.5 mg.

pyrilamine maleate 12.5 mg.)

Dormethan

(brand of dextromethorphan HBr) 30 mg.

Terpin hydrate 180 mg.

APAP (N-acetyl-p-aminophenol) 325 mg.

References: 1. Lhotka. F. M.: Illinois M. J. 112:259
(Dec.) 1957. 2. Fabricant. N. D.: E.E.N. T. Monthly 37:460
(July) 1958. 3. Farmer. D. F.: Clin. Med. 5:1183 (Sept.)
1958. 4. Bonica, J. J.: in Drops of Choice. Mosby. St.
Louis, 195S. p. 272. 5. Dascomb. H. E.: in Current
Therapy, Saunders. Phila.. 195S, p. 78. 6. Bickerman, H.
A.: in Drugs of Choice. Mosby. St. Louis, 195S, p. 547.

Controls cough centrally
with non-narcotic Dormethan, possess-
ing "amply demonstrated" antitussive
activity," as effective as codeine.

Liquefies tenacious mucus

with terpin hydrate, classic expectorant.

Prompt and prolonged relief because of
this special "timed release" design:

first — the outer layer
dissolves within minutes to
give 3 to 4 hours of relief

then — the inner core
releases its ingredients
to sustain relief for 3 to
4 more hours

Dosage: One tablet in the morning, midafternoon
and at bedtime. Pediatric dosage chart for
Tussagesic Suspension available on request.

TUSSAGESIC SUSPENSION provides palatability and convenience which make it
especially attractive to children and other patients who prefer liquid medication.

SMITH-DORSEY • a division of The Wander Company • Lincoln, Nebraska

September, 1960

ADVERTISEMENTS

LV

LVI

NORTH CAROLINA MEDICAL JOURNAL

September, 10HO

when
sulfa
is

your
plan

of
therapy. . .

\

KYN

Sulfamethoxypyridazine Lederle

OUTSTANDING 1-DOSE-A-DAY SULFA

Rapid peak attainment in 1 to 2 hours1,2 . . . approximately one-half the time of other
single-daily dose sulfas.2 High free levels— as much as 95 per cent of circulating levels
remaining in fully active unconjugated forms.3 Extremely loiv 2.7 per cent incidence of
side effects in toxicity studies on 223 patients.4 Includes total reactions ( subjective and
objective) , all temporary and rapidly reversed. No crystalluria reported.

KYNEX TABLETS, 0.5 Gm., bottles of 24 and 100. Dosage: Adults, 0.5
Gm. (1 tablet) daily following an initial first day dose of 1 Gm. (2 tablets).
KYNEX ACETYL PEDIATRIC SUSPENSION, cherry-flavored, 250 mg.
sulfamethoxypyridazine activity per ts p. (5cc). Bottles of4and16fl.oz.
New KYNEX ACETYL PEDIATRIC DROPS, cherry-flavored. 125 mg.
sulfamethoxypyridazine activity per cc. In 10 cc. squeeze bottle.
New for acute G. U. infection AZO KYNEX TABLETS (forq id. dos-
age), 125 mg, KYN EX Sulfa methoxypyridazine in the shell with 150 mg.
phenylazodiaminopyrldine HCI in the core.

Precautions: Usual sulfonamide precautions apply.
1. Boger, W. P.; Strickland, C. S., and Gylfe, J. M.l Anti-
biotic Med. & Clin. Ther. 3:378 (Nov.) 1056. 2. Boger, W. P.:
In: Antibiotics Annual 1958-1959, New York, Medical Encyclo-
pedia, Inc., 1959, p. 48. 3. Sheth, U. K. : Kulkarni. B. S.. and
Kamath, P. G. : Antibiotic Med. & Clin. Ther. 5:804 (Oct.) 1958.
4. Anderson, P. C and Wissinger, H. A. : U. S. Armed Forces
M. J. 10:1051 (Sept.) 1959.

LEDERLE LABORATORIES, a Division of AMERICAN CYANAMID COMPANY, Pearl River, New York

September, 1960

ADVERTISEMENTS

LVII

How to fee
Carefree
Without
Hardly
Trying . . .

It really takes a load off your mind. . .
to know that you are protected from
loss of income due to illness or accident'

"Dr. Carefree" has no 30-day
sick leave ... no Workmen's
Compensation . . . BUT he has a
modern emergency INCOME PROTEC-
TION PLAN with Mutual of Omaha.

When he is totally disabled by accident or sickness covered by this plan, this plan
will give him emergency income, free of Federal income tax, eliminating the night-
mare caused by a long disability.

Thousands of members of the Medical Profession are protected with Mutual of Oma-
ha's PROFESSIONAL MEN'S PLAN, especially designed to meet the needs of the
profession.

If you do not already own a Mutual of Omaha INCOME PROTECTION PLAN, get in
touch now with the nearest General Agent, listed below. You'll get full details, with-
out obligation.

Mutuah

OF OMAH

Largest Exclusive Health and Accident Company in the World.

G. A. RICHARDSON, General Agent
Winston-Salem, N. C.

J. A. MORAN, General Agent
Wilmington, N. C.

J. P. GILES, General Agent
Asheville, N. C.

LVIII

NORTH CAROLINA MEDICAL JOURNAL

September, 19H0

Hfor a smooth
downward curve

New Rautrax-N results in prompt lowering of blood pres-
sure.' Rautrax N, a new and carefully developed antihyper-
tensive-diuretic preparation, provides improved therapeutic
action1 plus enhanced diuretic safety for all degrees of essen-
tial hypertension. A combination of Raudixin and Naturetin,
Rautrax N facilitates the management of hypertension when
rauwolfia alone proves inadequate, or when prolonged treat-
ment, with or without associated edema, is indicated.
Naturetin, the diuretic of choice, also possesses marked
antihypertensive properties, thus complementing the known
antihypertensive action of Raudixin. In this way a lower
dose of each component in
Rautrax-N controls hyper-
tension effectively with
few side effects and
greater margin
of safety.

1-16

Other advantages are a balanced electrolyte pattern116 and
the maintenance of a favorable urinary sodium-potassium
excretion ratio.216 Clinical studies15 have shown that the
diuretic component of Rautrax-N — Naturetin — has only a
slight effect on serum potassium. The supplemental potas-
sium chloride provides additional protection against potas-
sium depletion which may occur during long term therapy.

Rautrax-N may be used alone or in conjunction with other
antihypertensive drugs, such as ganglionic blocking agents,
veratrum or hydralazine, when such regimens are needed
in the occasionally difficult patient.

Supply: Rautrax-N — capsule-shaped tablets providing 50
mg. Raudixin (Squibb Rauwolfia Serpentina Whole Root)
and 4 mg. Naturetin (Squibb Benzydroflumethiazide), with
400 mg. potassium chloride.

Dosage: Initially- 1 to 4 tablets daily after meals. Mainte-
nance-1 or 2 tablets daily after meals; maintenance dosage
may range from 1 to 4 tab-
lets daily. For complete in-
structions and precautions
see package insert. Litera-
ture available on request.

References: 1. Reports to the Squibb
Institute, 1960. 2. David, N. A.;
Porter, G.A., and Gray, R. H.: Mono-
graphs on Therapy 5:60 (Feb.) 1960.
3. Stenberg, E. S., Jr.; Benedetli, A.,
and Forsham, P. H.: Op. cit. 5:46
(Feb.) 1960.4. Fuchs, M.; Moyer, J.
H., and Newman, B. E.: Op. cit. 5:55
(Feb.) I960. 5. Marriott, H.J. L.,~and
Schamroth, Li Op. cit. 5:14 (Feb.)
1960. 6. Ira,£. H., Jr.; Shaw, D. M..
and Bogdonoff, M. D.: North Carolina
M. J. 21:19 (Jan.) 1960. 7. Cohen, B.
M.i M. Times, to be published. 8.
Breneman, G. M. and Keyes, J. W.:
Henry Ford Hosp. M. Boll. 7:281
(Dec.) 1959. 9. Forsham, P. H.:
Squibb Clin. Res. Notes 2:5 (Dec.)
1959. 10. Larson, E.: Op. cit. 2_:10
(Dec.) 1959. 11. Kirkendall, W. M.:
Op. cit. 2:11 (Dec.) 1959. 12. Yu, P.
N.: Op. cit. 2:12 (Dec.) 1959. 13.
Weiss, S.; Weiss, J., and Weiss, B.:
Op. cit. 2:13 (Dec.) 1959. 14. Moser,
M.: Op. cit. 2:13 (Dec.) 1959. 15.
Kahn, A., and Grenblatt, I. J.: Op. cit.
2:15 (Dec.) 1959. 16. Grollman, A.:
Monographs on Therapy
5:1 (Feb.) 1960.

Squibb Quality-the
Priceless Ingredient

SQUIBByJSH

The proved, effective antihypertensive—
now combined with a safer, better diuretic

RAUTRAX-N

Squibb Standardized Whole Root Rauwolfia Serpentina (Raudixin)
and Seniydratlumethiazide (*Naturetin) with Potassium Chloride

September, 1960

ADVERTISEMENTS

LIX

■ ■■ ®

brand of phenylbutazone

Geigy

Proved by a Decade of Experience
Confirmed by 1700 Published Reports
Attested by World-Wide Usage

Since its anti-inflammatory properties
were first noted in Geigy laboratories 10
years ago, time and experience have
steadily fortified the position of
Butazolidin as a leading nonhormonal
anti-arthritic agent. Indicated in both
chronic and acute forms of arthritis,
Butazolidin is noted for its striking
effectiveness in relieving pain,
increasing mobility and halting
inflammatory change.

Butazolidin®, brand of phenylbutazone:
Red, sugar-coated tablets of 100 mg.
Butazolidin® Alka: Orange and white
capsules containing Butazolidin 100 mg.;
dried aluminum hydroxide gel 100 mg.;
magnesium trisilicate 150 mg.;
homatropine methylbromide 1.25 mg.

Geigy, Ardsley, New York
162-60

LX

NORTH CAROLINA MEDICAL JOURNAL

September, 1960

- in common

Gram-positive

infections

clue to

susceptible

organisms

YOU CAN

COUNT ON

®

TAG

(triacetyloleandomycin)

even

in many

resistant

Staph*

1,928 published cases in the two years since
TAO was released tor general use show:

94.3% effectiveness in respiratory infections (617 cases

including tonsillitis, staphylococcal and streptococcal pharyngi-
tis, bronchitis, infectious asthma, broncho-pneumonia, lobar
pneumonia, bronchiectasis, lung abscess, otitis.)

You can count on TAO.

92% effectiveness in skin and soft tissue infections (900

cases including pyoderma, impetigo, acne, infected skin disor-
ders, wounds, incisions and burns, furunculosis, abscess, celluli-
tis, chronic ulcer, adenitis.) You can count on TAO.

87.1% effectiveness in genitourinary infections (349

cases including urethritis, cystitis, pyelitis, pyelonephritis, orchi-
tis, pelvic inflammation, acute gonococcal urethritis, lympho-
granuloma venereum.) You can count on TAO.

75.8% effectiveness in diverse tnfections(62 cases includ-
ing fever of undetermined origin, peritoneal abscess, osteitis,
periarthritis, septic arthritis, staphylococcal enterocolitis, gas-
troenteritis, carriers of staphylococci.) You can count on TAO.

95.6% of 1,928 cases free of side effects-in the remain-
ing 4.4%, reactions were chiefly mild gastrointestinal disturb-
ances which seldom necessitated discontinuance of therapy.

*ln 884 of 1,928 cases the causative organisms were mostly

staphylococci. The majority of clinical isolates were found to be

resistant to at least one of the commonly used antibiotics and

many patients had failed to respond to previous therapy with one

or more antibiotics. TAO proved 93.4% effective in these 884

cases.

Complete bibliography available on request.

DOSAGE: varies according to severity of infection. Usual adult

dose— 250 to 500 mg. q.i.d. Usual pediatric dose: 3-5 mg. lb.

body weight every 6 hours.

NOTE: In some children, when TAO was administered at considerably
higher than therapeutic levels for extended periods, transient-jaundice
and other indications of liver dysfunction have been noted. A rapid and
complete return to normal occurred when TAO was withdrawn.

SUPPLY: TAO CAPSULES — 250 mg. and 125 mg., bottles of 60.
TAO ORAL SUSPENSION -125 mg. per 5 cc. when reconstituted,
palatable cherry flavor, 60 cc. bottles. TAO PEDIATRIC DROPS-
100 mg. per cc. when reconstituted, flavorful; special calibrated
dropper, 10 cc. bottles. INTRAMUSCULAR or INTRAVENOUS -
10 cc. vials, as oleandomycin phosphate.

OTHER TAO FORMULATIONS ALSO AVAILABLE: TA05-AC (Tao, analgesic,
antihistamine compound) capsules, bottles of 36. TAOMID=' (Tao with
Triple Sulfas) — tablets, bottles of 60. Oral Suspension-60 cc. bottles.

For nutritional support VI ERR A Vitamins and Minerals

Formulated from Pfizer's line of fire pharmaceutical products.

New York 17, N.Y.

Division, Chas. Pfizer & Co., Inc.

Science for the World's Weil-Being"

September, 1960

ADVERTISEMENTS

LXI

Each of the babies pictured on this page
was borne by a mother with a documented
previous history of true habitual abor-
tion, who was treated with delalutin
during the pregnancy leading to this birth

LIVING PROOF OF FETAL SALVAGE WITH

DELALUTIN

SQUIBB HYDROXYPROGESTERONE CAPROATE

Improved Progestational Therapy

Garden City, N. Y.

Roselle, 111.

Seaford, N. Y.

Hartford, Conn. East Williston, N. Y. Norwich, Vt.

delalutin offers these advantages over other progestational agents

• long-acting sustained therapy • more effective in producing and maintaining a
completely matured secretory endometrium • no androgenic effect • more concen-
trated solution requiring injection of less vehicle • unusually well-tolerated, even in
large doses • fewer injections required • low viscosity makes administration easy

Complete information on administration and dosage is supplied in the package insert

Vials of 2 and 10 cc, each containing 125 mg. of hydroxyprogesterone caproate in benzyl benzoate and sesame oil.
Also available: DELALUTIN 2X in 5 cc. multiple-dose yials. Each cc. contains 250 mg. hydroxyprogesterone caproate
in castor oil, preserved with benzyl alcohol.

SQUIBB (III jf lis) Squibb Quality — The Priceless Ingredient

■OELALUTIN'® IS A SQUIBB TRADEMARK

LXII

NORTH CAROLINA MEDICAL JOURNAL

September, 1960

Use of pHisoHex for washing the skin aug-
ments any other therapy for acne — brings
better results. Now, pHisoAc Cream, a new
acne remedy for topical application, sup-
presses and masks lesions — dries, peels and
degerms the skin. Together, pHisoHex and
pHisoAc provide basic complementary topical
therapy for acne.

pHisoHex, antibacterial detergent with 3 per
cent hexachlorophene, removes soil and oil
better than soap — provides continuous de-
germing action when used often. pHisoHex is
nonalkaline, nonirritating and hypoallergenic.

When pHisoAc Cream is used with pHisoHex
washings, it unplugs follicles, helps prevent

development of comedones, pustules and
scarring. New pHisoAc Cream is flesh-toned,
not greasy. It contains colloidal sulfur 6 per
cent, resorcinol 1.5 percent, and hexachloro-
phene 0.3 per cent in a specially prepared
base. pHisoAc is pleasant to use.

A new "self-help" booklet, Teen-aged? Have
acne? Feel lonely?, gives important psycho-
logic first aid for patients with acne and
describes the proper use of pHisoHex and
pHisoAc. Ask your Winthrop representative
for copies.

pHisoAc is available in IV2 oz. tubes and
pHisoHex is available in 5 oz. plastic squeeze
bottles and in bottles of 16 oz.

pHisoHex8 and pHisoAc for acne

trademark

'laboratories I

New York 18. N. Y.

September, 1960

ADVERTISEMENTS

LXIII

ACTIVITY

Our daily activities demand energy from food
... as does maintenance of healthy bodies . . .
repair of sick ones . . . and growth of young ones.
The amount of energy demanded varies from
level of activity . . . body size . . . stage of growth
. . . pregnancy . . . lactation . . . and state of health.

Food intake is largely controlled by our body"s
demand for energy. Wise selection of food is
necessary to insure that we satisfy nutrient needs
while we satisfy energy demands.

Foods combined in the minimum amounts sug-
gested in A Guide to Good Eating provide most
of the nutrient needs and about 2/3 the energy
needs of the average healthy active adult. Of the
adult Recommended Dietary Allowance, these
amounts of

milk and dairy foods supply about 1 \i of the cal-
ories . . . foods in the meat group supply about 1 Is
of the calories . . . vegetables and fruits supply
about 1 /g of the calories . . . breads and cereals
supply about • /8 of the calories.

More of these or other foods . . . with mod-
erate use of sugars and syrups, fats and oils in
food preparation and at the table . . . quickly
increase the calorie intake to meet energy needs.
An adequate supply of energy is essential if the
body is to make efficient use of dietary protein.

A GUIDE TO GOOD EATING — USE daily
DAIRY FOODS

3 to 4 glasses milk — children • 4 or more glasses —
teenagers • 2 or more glasses — adults • Cheese, ice
cream and other milk-made foods can supply part of
the milk

MEAT GROUP
2 or more servings • Meats, fish, poultry, eggs, or
cheese — with dry beans, peas, nuts as alternates

VEGETABLES AND FRUITS

4 or more servings • Include dark green or yellow
vegetables; citrus fruit or tomatoes

BREADS AND CEREALS

4 or more servings • Enriched or whole-grain added
milk improves nutritional values

Thus, even in reducing diets, calories from carbo-
hydrates and fats should be included.

When combined in well-prepared meals, foods
selected from each of these four food groups can
satisfy the tastes, appetites and energy needs of
all members of the family . . . young and old.

The nutritional statements made in this adver-
tisement have been reviewed by the Council on
Foods and Nutrition of the American Medical
Association and found consistent with current
authoritative medical opinion.

Since 1915 . . . promoting better health
through nutrition research and education.

NATIONAL DAIRY COUNCIL

A non-profit organization
111 N. Canal Street • Chicago 6, 111.

This information is reproduced in the interest of good nutrition and health by the Dairy

Council Units in North Carolina.
High Point-Greensboro Winston-Salem Burlington-Durham-Raleigh

310 Health Center Bldg.

106 E. Northwood St.
Greensboro, N. C.

610 Coliseum Drive
Winston-Salem, N. C.

Durham, N. C.

LXIV

NORTH CAROLINA MEDICAL JOURNAL

September. 1960

Income for th

e members o

f the

North Carolina Medical Profession

Pays From The First Day of Medical Attention Dur-
ing Total Disability and Total Loss of Time Because
of SICKNESS or ACCIDENT Originating After the
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House Confinement not required at any time.

Accidental loss of hands, feet or eyesight pays monthly benetits —

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EXTRA BENEFITS — Double monthly benefits while you are hospi-
talized payable for as long as three months.
Cash benefits for accidental death.

Double income benefits if disabled in specified travel accident
named in the policy.

OTHER IMPORTANT FEATURES — Waiver of Premium Provision.
Limited Commercial Air Line Passenger Coverage. No Automatic
Termination Age During Policy Period. A Special Renewal Agree-
ment.

EFFECTIVE DATES OF COVERAGES — EXCEPTIONS

This policy covers accidents from Noon of the Policy date and sickness originating more
than thirty days after the Policy Date, unless specifically excluded — except — the policy
does not cover, and the premium includes no charge for loss which is caused by: war or any
act of war or while in military service of any country at war; suicide or attempted suicide;
insanity or mental derangement; travel outside the United States, Alaska or Canada (un-
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September, 1960

ADVERTISEMENTS

LXV

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TETRAVAX IS A TRADEMARK OF MERCK « CO., INC.

MERCK SHARP & DOHME, division of merck & co., inc., Philadelphia i, pa.

LXVI

NORTH CAROLINA MEDICAL JOURNAL

September, 19(!0

THIS

Doctor

Here Are the BUREAUS in

MEDICAL-DENTAL CREDIT BUREAU
514 Nissen Building
P. O. Box 3136
Winston-Salem, N. C.
Phone PArk 4-8373

MEDICAL-DENTAL CREDIT BUREAU

715 Odd Fellows Building

Roleigh, N. C.

Phone TEmple 2-2066

MEDICAL-DENTAL CREDIT BUREAU
513 Security Bank Building
High Point, N. C.
Phone 3955

MEDICAL-DENTAL CREDIT BUREAU
A division of Carolina Business Services
Room 10 Masonic Temple Building
P. O. Box 924
Wilmington, N. C.
Phone ROger 3-5191

IS ,he SYMBOL 0F ASSURANCE OF ETHICAL
public relations minded handling of your accounts
receivable and collection problems.

IS ,he EMBLEM of sound experience in SERVICE
to the professional offices.

IS ,he MARK of a complete PROFESSIONAL
accounts receivable service.

Your Area Capable and Ready to Serve You

MEDICAL-DENTAL CREDIT BUREAU
212 West Gaston Street
Greensboro, N. C.
Phone BRoodwoy 3-8255

MEDICAL-DENTAL CREDIT BUREAU
220 East 5th Street
Lumberton, N. C.
Phone REdfield 9-3283

MEDICAL-DENTAL CREDIT BUREAU, INC.

225 Hawthorne Lane

Hawthorne Medical Center

Charlotte, N. C.

Phone FRanklin 7-1527

THE MEDICAL-DENTAL CREDIT BUREAU
Westgate Regional Shopping Center
Post Office Box 2868
Asheville, North Carolina
Phone ALpine 3-7378

TUCKER HOSPITAL, Inc.

212 West Franklin Street
Richmond, Virginia

A private hospital for diagnosis and treatment of psychiatric and neurol-
ogical patients.
Hospital and out-patient services.

(Organic diseases of the nervous system, psychoneuroses, psychosomatic
disorders, mood disturbances, social adjustment problems, involutional
reactions and selective psychotic and alcoholic problems.)

Dr. James Asa Shield

Dr. Weir M. Tucker

Dr. George S. Fultz

Dr. Amelia G. Wood

September, 1960

ADVERTISEMENTS

LXVII

SAINT ALBANS

PSYCHIATRIC HOSPITAL

(A Non-Profit Organization)

Radford, Virginia

James P.
Daniel D. Chiles, M. D.

Clinical Director
James K. Morrow, M. D.
Silas R. Beatty, M. D

STAFF

<ing, M. D., Director

William D. Keck, M. D.
Edward W. Gamble, III, M. D.
J. William Giesen, M. D.
Internist (Consultant)

Clinical Psychology: Don Phillips
Thomas C. Camp, Ph. D. Administrator
Artie L. Sturgeon, Ph. D.

AFFILIATED CLINICS
Bluefield Mental Health Center Beckley Mental Health Center

525 Bland St., Bluefield, W. Va. 109 E. Main Street, Beckley, W. Va.
David M. Wayne, M. D. W. E. Wilkinson, M. D.
Phone: DAvenport 5-9159 Phone: CLifford 3-8397
Charleston Mental Health Center Norton Mental Health Clinic

1119 Virginia St., E., Charleston, W. Va. Norton Community Hospital, Norton, Va.
B. B. Young, M. D. Pierce D. Nelson, M. D.
Phone: Dickens 6-7691 Phone: 218, Ext. 55 and 56

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LXVIII

NORTH CAROLINA MEDICAL JOURNAL

September, 19G0

0

Old age

Whenever
the diet is faulty,
the appetite poor,
or the loss of food
is excessive

through vomiting

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or diarrhea —

• ' Adoles

cence

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Volenti

MEAT EXTRACT

stimulates the appetite,

increases the flow of
digestive juices,

provides: supplementary
amounts of vitamins, minerals
and soluble ptoteins,

extra-dietary vitamin B12,

protective quantities of
potassium, in a palatable and
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conditions

Supplied in bottles of 2 or 6 fluidounces.

Dosage is 1 teaspoonful two or three times
daily; two or three times this amount for
potassium therapy.

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When the physician writes "DR"
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Clinical samples sent to physicians on request

Davies, Rose & Company, Limited
Boston 18, Mass.

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0-7

Septtmber, 1960

ADVERTISEMENTS

LXIX

BRAWNER'S SANITARIUM, INC.

(Established 1910)
2932 South Atlanta Road, Smyrna, Georgia

FOR THE TREATMENT OF PSYCHIATRIC ILLNESSES
AND PROBLEMS OF ADDICTION

MODERN FACI LITI ES

Approved by Central Inspection Board of American Psychiatric Association
and the Joint Committee on Accreditation

Jas. N. Brawner, Jr., M.D.
Medical Director

Phone HEmlock 5-4486

HIGHLAND HOSPITAL, INC.

Founded In 1904

ASHEVILLE, NORTH CAROLINA

Affiliated with Duke University

A non-profit psychiatric institution, offering modern diagnostic and treatment procedures — insulin, electroshock, psy-
chotherapy, occupational and recreational therapy — for nervous and mental disorders.

The Hospital is located in a 75-acre park, amid the scenic beauties of the Smoky Mountain Range of Western North
Carolina, affording exceptional opportunity for physical and emotional rehabilitation.

The OUT-PATIENT CLINIC offers diagnostic service and therapeutic treatment for selected case desiring non-
resident care.

R. CHARMAN CARROLL, M.D. ROBERT L. CRAIG, M.D. JOHN D. PATTON, M.D.
Medical Director Associate Medical Director Clinical Director

LXX

NORTH CAROLINA MEDICAL JOURNAL

September, 19C0

APPALACHIAN HALL

ASHEVILLE

ESTABLISHED — 1916

NORTH CAROLINA

An Institution for the diagnosis and treatment of Psychiatric and Neurological illnesses, rest, convalescence, drug

and alcohol habituation.

Insulin Coma, Electroshock and Psychotherapy are employed. The Institution is eauipped with complete laboratory

facilities including electroencephalography and X-ray.

Appalachian Hall is located in Asheville, North Carolina, a resort town, wnich justly claims an all around climate

for health and comfort. There are ample facilities for classification of patients, rooms single or en suite.

Wm. Ray Griffin, Jr., M.D.
Robert A. Griffin, M.D.

For rates and further information write

Mark A. Griffin, Sr., M.D.
Mark A. Griffin, Jr., M.D.

APPALACHIAN HALL, ASHEVILLE, N. C.

When too many tasks

seem to crowd

the unyielding hours,

a welcome

"pause that refreshes"

with ice-cold Coca-Cola

often puts things

into manageable order.

September, 1960

ADVERTISEMENTS

LXXI

INDEX TO ADVERTISERS

American Casualty Insurance Company Reading

Ames Company LII

Appalachian Hall LXX

Ayerst Laboratories XXIII

Brawner's Sanitarium LXIX

Brayten Pharmaceutical Company XXV

George A. Breon LIII

Bristol Laboratories XXVI, XXXIII, XL

Burroughs-Wellcome & Company XLIX

Carolina Surgical Supply Co Reading

Coca Cola Bottling Company LXX

Columbus Pharmacal Company LV

J. L. Crumpton XXXVIII

Dairy Council of North Carolina LXIII

Davies, Rose & Co LXVIII

Drug Specialties, Inc Insert

Endo Laboratories XXXI

Florida Citrus Commission XXIV

Geigv Pharmaceutical XLV, LIX

General Electric X-Ray Dept XLVII

Glenbrook Laboratories (Bayer Co.) XLIII

Charles C. Haskell and Company XLI

Highland Hospital LXIX

Hospital Saving Assn. of N. C XXXV

Jones and Vaughan, Inc Ill

Lederle Laboratories IV, V, XXXVI, XXXVII,

XLVIII, LVI

Eli Lilly & Company XXXIV, Front Cover

The S. E. Massengill Company L

Mayrand, Inc LI

Medical-Dental Credit Bureau LXVI

Merck, Sharp & Dohme Second Cover, VI,

VII, XLVI, LXV

Monarch Elevator and Machine Co LXVII

Mutual of Omaha LVII

Parke, Davis & Co LXXII, Third Cover

Physicians Casualty Association

Physicians Health Association LXVII

Physicians Products Company XVIII

Pinebluff Sanitarium I

P. Lorillard Company (Kent Cigarettes) XXIX

A. H. Robins Company XII, XIII, XXI, XXXII

J. B. Roerig & Company IX, XVI, XVII,

XLIV, LX

Saint Albans Sanatorium LXVII

G. D. Searle & Co XXXIX

Smith-Dorsey Company XXII, XXVIII, LIV

Smith-Kline & French Laboratories 4th Cover

E. R. Squibbs and Sons XX, XLII, LVIII, LXI

St. Paul Fire and Marine Insurance LXXI

Tucker Hospital LXVI

United Insurance Company of America LXIV

U. S. Vitamin Company Reading

Valentine Company LXVIII

Wachtel's Incorporated Reading

Wallace Laboratories X, Insert, XI, XXX

Wesson Oil and Snowdrift

Sales Company XIV, XV

Winchester Surgical Supply Co.

Winchester-Ritch Co I

Winthrop Laboratories Insert, XIX,

XXVII, LXII

RY

CHOSEN BY MEDICAL
SOCIETY OF THE STATE OF
NORTH CAROLINA FOR
PROFESSIONAL
LIABILITY INSURANCE

for your complete insurance needs . . .

* PROFESSIONAL

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THERE IS A SAINT PAUL AGENT IN YOUR
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Head Office
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Charlotte, North Carolina
EDison 2-1633

HOME OFFICE: 385 WASHINGTON ST., ST. PAUL, MINN.

SERVICE OFFICE: RALEIGH, NORTH CAROLINA— 323 W. MORGAN ST. TEmple 4-7458

~ I

VIRTUALLY

■ -

DECREASE

STAPHYLOCOCCAL
SENSITIVITY

OVER AN 8-YEAR SPAN... TO

CHLOROMYCETIN

(chloramphenicol, Parke-Davis)
An outstanding and frequently reported characteristic of CHLOROMYCETIN1"8 "...is the fact
that the very great majority of the so-called resistant staphylococci are susceptible to its action."1
In describing their study, Rebhan and Edwards2 state that "...only a small percentage of strains
have shown resistance..." to CHLOROMYCETIN, despite steadily increasing use of the drug
over the years.

Fisher3 observes: "The over-all average incidence of resistance, for the 31,779 strains [of staph-
ylococci] through nine years was about 97o." Finland4 reports that, while the proportion of
strains resistant to several newer antibiotics has risen to between 10 and 30 per cent, such resist-
ance to CHLOROMYCETIN "...has been rare even where this agent has been used extensively."
Numerous other investigators concur in these findings.5-8

CHLOROMYCETIN (chloramphenicol, Parke-Davis) is available in various forms, including Kapscals® of
250 mg., in bottles of 16 and 100.

CHLOROMYCETIN is a potent therapeutic agent and, because certain blood dyscrasias have been asso-
ciated with its administration, it should not be used indiscriminately or for minor infections. Furthermore,
as with certain other drugs, adequate blood studies should be made when the patient requires prolonged
or intermittent therapy.

References: (1) Welch, H., in Welch, H., & Finland, M.: Antibiotic Therapy for Staphylococcal Diseases, New York,
Medical Encyclopedia. Inc., 1959, p. 1. (2) Rebhan, A. W„ & Edwards, H. E.: Canad. M. A. J. 82:513, 1960. (3) Fisher,
M. W: Arch. Int. Med. 105:413, 1960. (4) Finland, M„ in Welch, H.. & Finland, M.: Antibiotic Therapy for Staphy-
lococcal Diseases, New York. Medical Encyclopedia, Inc., 1959, p. 187. (5) Bercovitz, Z. X: Geriatrics 13:164, 1960.
(6) Clas, W. W., & Britt, E. M.: Management of Hospital Injections, in Symposium on Antibacterial Therapy, Michigan
& Wayne County Acad. Gen. Pract., Detroit, September 12, 1959, p. 7. (7) Staphylococcal Infections in Pediatrics,
Scientific Exhibit, Commission on Professional and Hospital Activities, 108th Ann. Meet., A. M. A., Atlantic City,

10 SENSITIVITY OF PYOGENIC STRAINS OF STAPHYLOCOCCI TO CHLOROMYCETIN OVER A PERIOD OF EIGHT YEARS*

100% j

■ 89%

98%
100%

98%
97% j
97%
97%

tfrcs were gathered over almost a decade on 329 children with staphylococcal pneumonia; 1,663 sensitivity tests were performed,
from Rebhan & Edwards.2

KE, DAVIS & COMPANY Detroit 32, Michigan

PARKE-DAVIS

to relieve anxiety either accompanying or causing somatic distress

advantages you can expect to see with

Stelazine

brand of trifluoperazine

• Prompt control of the underlying anxiety. Beneficial effects are often seen within 24-48 hours.

• Amelioration of somatic symptoms. Marx1 reported from his study of 43 office patients that
'Stelazine' "appeared to be effective for patients whose anxiety was associated with organic— as
well as functional disorders."

• Freedom from lethargy and drowsiness. Winkelman2 observed that 'Stelazine' "produces a
state approaching ataraxia without sedation which is unattainable with currently available neuro-
leptic agents; its freedom from lethargy and drowsiness makes ['Stelazine'] extremely well accepted
by patients."

Optimal dosage: 2-4 mg. daily. Available as 1 mg. and 2 mg. tablets, in bottles of 50 and 500.

N.B.: For further information on dosage, side effects, cautions and contraindications, see available comprehensive
literature, Physicians' Desk Reference, or your S.K.F. representative. Full information is also on file with your pharmacist.

SMITH
KLINES-?
FRENCH

1. Marx, F.J., in TriHunperazine: Further Clinical and Laboratory Studies, Philadelphia, Lea & Febiger, 19^9. P- 89

2. Winkelman, NAY., Jr.: thid., p. 78.

ORTH CAROLINA

IN THIS ISSUE:

PROBLEMS OF ADJUSTMENT OF GIFTED CHILDREN
— CORNELIUS LANSING, M.D.

now

Puivuies®

Ilosone

RECEIVED

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DIVISION OF
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Ilosone* (propionyl erythromycin ester lauryl sulfate, Lilly)

ELI LILLY AND COMPANY • INDIANAPOLIS 6, I N D I A N A, U. S. A.

Sfay

Table of Contents, Page II

1INICAL REMISSION

(A "PROBLEM" ARTHRITIC

'escaping" rheumatoid arthritis. After gradually "escaping" the ther-
utic effects of other steroids, a 52-year-old accountant with ar-
tis for five years was started on Decadron, 1 mg. /day. Ten months
ir, still on the same dosage of Decadron, weight remains constant,
has lost no time from work, and has had no untoward effects. She
i clinical remission.*

convenient b-i.d. alternate dosage schedule: the degree and extent of relief provided by
(DRON allows for b.i.d. maintenance dosage in many patients with so-called "chronic" condi-
;. Acute manifestations should first be brought under control with a t.i.d. or q.i.d. schedule.

ilied: As 0.75 mg. and 0.5 mg. scored, pentagon-shaped tablets in bottles of 100. Also available
jection DECADRON Phosphate. Additional information on DECADRON is available to physicians
:quest. DECADRON is a trademark of Merck & Co., Inc.

i a clinical investigator's report to Merck Sharp & Dohme.

lecadron*

(EATS MORE PATIENTS MORE EFFECTIVELY

^ MERCK SHARP & DOHME • Division of Merck & Co., INC., West Point, Pa.

u

A Sanitarium for Rest Under Medical Supervision, and Treatment of Nervous
and Mental Diseases, Alcoholism and Drug Addiction,

The Pinebluff Sanitarium is situated in the sandhills of North Carolina in a 60-acre park
of long pines. It is located on U. S. Route 1. six miles south of Pinehurat and Southern
Pines. This section is unexcelled for its healthful climate.

Ample facilities are afforded for recreational and occupational therapy, particularly out-
of-doors.

Special stress is laid on psychotherapy. An effort is made to help the patient arrive at
an understanding of his problems and by adjustment to his personality difficulties or
modification of personality traits to effect a cure or improvement in the disease. Two resident
physicians and a limited number of patients afford individual treatment in each case.

For further information write:

The Pineblu££ Sanitarium, Pinebiuffi, N. c.

Malcolm D. Kemp, M.D.

Medical Director

CUT BOOKKEEPING — OFFICE AND TAX EXPENSES TO A MINIMUM

USE

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WINCHESTER

"CAROUNAS' HOUSE OF SERVICE'

WINCHESTER SURGICAL SUPPLY CO.
119 East 7th Street Charlotte, N. C.

WINCHESTER-RITCH SURGICAL CO.
421 West Smith St. Greensboro, N. C.

II

NORTH CAROLINA MEDICAL JOURNAL

October, 1960

North Carolina Medical Journal

Official Organ of
The Medical Society of the State of North Carolina

Volume 21
No. 10

October, 1960

75 TENTS A COPY
$6.00 * VEAK

CONTENT

Original Articles

Problems of Adjustment of Gifted Children —
Cornelius Lansing-, M.D 441

A Followup of Psychosis Among- Felons in the
North Carolina Prison System — Martin H.
Keeler, M.D., and Harley C. Shands, M.D. . 446

Berylliosis, Bones, and Behavior: An Illustra-
tive Case Report — Charles R. Rackley, M.D..
and Morton D. Bogdonoff, M.D 450

The Larynx in Health and in Disease: A Pho-
tographic Study— J. C. Peele, M.D 458

Chronic Disease Program in the Charlotte-
Mecklenburg Health Department — Elizabeth
Conard Corkey, M.D 464

Hepatic Amebiasis Treated with Plaquenil: A

Case Report— Hugh O. Queen, M.D. ... 468

Report from the Duke University Poison Con-
trol Center— J. A. Arena, M.D 469

Bulletin Board

Coming Meetings 475

New Members of the State Society .... 475

News Notes from the University of North Car-
olina School of Medicine 475

News Notes from the Bowman Gray School of
Medicine of Wake Forest College .... 476

North Carolina Chapter, Professional Group
on Medical Electronics 477

Announcements 477

Book Reviews

482

Editorials

Medical Research, Choked by Dollars .

Imaginary Poverty

Evangelist Says World End Near .

Project Hope

Blue Shield and the New Challenge .

471
472
472
473
473

The Month in Washington

483

In Memoriam

484

President's Message

The Medical Stake in Politics — Amos N. John-
son, M.D 474

Index to Advertisers
lxvii

Entered as second-class matter January 2. 1940. at the Post Office at Winston-Salem, North Carolina, under the Act of
August 24, 1912. Copyright 1960 by the Medical Society of the State of North Carolina.

7JC

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provide a smooth, free-flowing suspension in which settling is minimal and can be
easily shaken.

1. Shore, P.D., Flippin, H.F., and Reinhold, J.G., Am. J. M. Sc, 218:80 (July) 1949.
• Federal law prohibits dispensing without prescription.

mawm

PRODUCTS CO., INC.

PETERSBURG, VIRGINIA

October, 1960

ADVERTISEMENTS

More than keeping abreast . . . keeping ahead!

Plan to
attend the

AMA

14th Clinical Meeting

Washington, D.C.

Registration and Exhibits
National Guard Armory
November 28, 29, 30, December 1

Use any means but by aj] means attend this
session— an informative cross-section of
medicine for all physicians.

& OVER 100 SCIENTIFIC PAPERS
i- OVER 100 SCIENTIFIC EXHIBITS
vr OUTSTANDING SYMPOSIA & PANELS

See October 1 and October 22 JAMA for hotel and meeting
registration forms. . .Complete scientific program of
Clinical Meeting appears in October 22 JAMA

/

/ AMERICAN MEDICAL ASSOCIATION

535 North Dearborn Street, Chicago 10, Illinois

/

"Gratifying" relief from

for your patients with
low back syndrome9 and
other musculoskeletal disorders

POTENT muscle relaxation
EFFECTIVE pain relief
SAFE for prolonged use

stiffness and pain

a , T * "

J^rJXir y llli^ relief from stiffness and pain

in 106 -patient controlled study

(as reported inJ.A.M.A., April 30, 1960)

"Particularly gratifying was the drug's [Soma's]
ability to relax muscular spasm, relieve pain, and
restore normal movement ... Its prompt action,
ability to provide objective and subjective assist-
ance, and freedom from undesirable effects rec-
ommend it for use as a muscle relaxant and anal-
gesic drug of great benefit in the conservative
management of the 'low back syndrome'."

Kestler, O.: Conservative Management of "Low Back Syndrome" ,

J.A.M.A. 172: 2039 (April 30) 1960.

FASTER IMPROVEMENT- 19% complete or marked

improvement in 7 days (Kestler)

EASY TO USE-Usual adult dose is one 350 mg. tablet
three times daily and at bedtime.

SUPPLIED: 350 mg., white tablets, bottles of 50.

For pediatric use, 250 mg., orange capsules, bottles of 50.

Literature and samples on request.

(CARISOPRODOL, WALLACE)

^^ WALLACE LABORATORIES, CRANBURY, NEW JERSEY

VIII NORTH CAROLINA MEDICAL JOURNAL October, 1900

Medical Society of the State of North Carolina

OFFICERS — I960

President — Amos Neill Johnson, M.D., Garland

President Elect — Claude B. Squires, M.D., 225 Hawthorne Lane, Charlotte
Past President — John C. Reece, M.D., Grace Hospital, Morganton
First Vice-President — Theodore S. Raiford, M.D., Doctors Building, Asheville
Second Vice-President — Charles T. Wilkinson, M.D., Wake Forest
Secretary— John S. Rhodes, M.D., 700 West Morgan Street, Raleigh
Executive Director — Mr. James T. Barnes, 203 Capital Club Building, Raleigh
The President, Secretary and Executive Director are members ex-officio

of all committees
Speaker-House of Delegates — Donald B. Koonce, M.D., 408 N. 11th St., Wilmington
Vice-Speaker-House of Delegates — E. W. Schoenheit, M.D., 46 Haywood St., Asheville

COUNCILORS — 1958 - 1961

First District— T. P. Brinn, M.D., 118 W. Market Street, Hertford

Vice Councilor — Q. E. Cooke, M.D., Murfreesboro
Second District — Lynwood E. Williams, M.D., Kinston Clinic, Kinston

Vice Councilor— Ernest W. Larkin, Jr., M.D., 211 N. Market St., Washington
Third District — Dewey H. Bridger, M.D., Bladenboro

Vice Councilor — William A. Greene, M.D., 104 E. Commerce St., Whiteville
Fourth District — Edgar T. Beddingfield, Jr., M.D., P.O. Box 137, Stantonsburg

Vice Councilor — Donnie H. Jones, M.D., Box 67, Princeton
Fifth District— Ralph B. Garrison, M.D., 222 N. Main Street, Hamlet

Vice Councilor — Harold A. Peck, M.D., Moore County Hospital, Pinehurst
Sixth District — George W. Paschal, Jr., M.D., 1110 Wake Forest Rd., Raleigh

Vice Councilor— Rives W. Taylor, M.D., P.O. Box 1191, Oxford
Seventh District —

Vice Councilor— Edward S. Bivens, M.D., Stanly County Hospital, Albemarle
Eighth District— Merle D. Bonner, M.D., 1023 N. Elm Street, Greensboro

Vice Councilor — Harry L. Johnson, M.D., P.O. Box 530, Elkin
Ninth District — Thomas Lynch Murphy, M.D., 116 Rutherford St., Salisbury

Vice Councilor — Paul McNeely Deaton, M.D., 766 Hartness St., Statesville
Tenth District — William A. Sams, M.D., Main Street, Marshall

Vice Councilor — W. Otis Duck, M.D., Drawer 517, Mars Hill

DELEGATES TO THE AMERICAN MEDICAL ASSOCIATION

Elias S. Faison, M.D., 1012 Kings Drive, Charlotte

C. F. Strosnider, M.D., 111 E. Chestnut Street, Goldsboro

Millard D. Hill, M.D., 15 W. Hargett Street, Raleigh

William F. Hollister, M.D., (Alternate), Pinehurst Surgical Clinic, Pinehurst

Joseph F. McGowan, M.D., (Alternate), 29 Market Street, Asheville

Wm. McN. Nicholson, M.D., (Alternate), Duke Hospital, Durham

SECTION CHAIRMEN 1959-1960

General Practice of Medicine — Julius Sader, M.D., 205 East Main Street, Brevard
Internal Medicine — Walter Spaeth, M.D., 116 South Road, Elizabeth City
Ophthalmology and Otolaryngology — Charles W. Tillett, Jr., M.D., 1511 Scott

Avenue, Charlotte
Surgery — James E. Davis, M.D., 1200 Broad Street, Durham
Pediatrics — William W. Farley, M.D., 903 West Peace Street, Raleigh
Obstetrics & Gynecology — H. Fleming Fuller, M.D., Kinston Clinic, Kinston
Public Health and Education — Isa C. Grant, M.D., Box 949, Raleigh
Neurology & Psychiatry — Myron G. Sandifer, M.D., N. C. Memorial Hospital,

Chapel Hill
Radiology — Isadore Meschan, M.D., Bowman Gray School of Medicine,

Winston-Salem
Pathology — Roger W. Morrison, M.D., 65 Sunset Parkway, Asheville
Anesthesia — Charles E. Whitcher, M.D., Route 1, Pfafftown
Orthopedics & Traumatology — Chalmers R. Carr, M.D., 1822 Brunswick Avenue,

Charlotte
Student AMA Chapters — Mr. John Feagin, Duke University School of Medicine,

Durham

brand of chlormezanone

effective oral skeletal
muscle relaxant
and tranquilizer

LETS THE PATIENT WALK
"HEADS UP"

in spite of torticollis.

N

■ *

r**P

Trancopal

relieves pain and spasm
associated with torticollis.

In a recent study by Ganz, Trancopal brought considerable
improvement or very effective relief to 20 of 29 patients
with torticollis.1 "The patients helped by the drug," states
Ganz, "were able to carry the head in the normal position
without pain." Similarly, Kearney found that in 8 of 13
patients with chronic torticollis treated with Trancopal
improvement was excellent to good. ". . . Trancopal is the most
effective oral skeletal muscle relaxant and mild tranquilizer
currently available."2

Lichtman, in a study of patients with various musculoskel-
etal conditions, noted that 64 of 70 patients with torticollis
obtained excellent to good relief with Trancopal.

In a comparative study of four central nervous system
relaxants, Lichtman reports that 26 of 40 patients
found Trancopal to be the most effective drug.3

Trancopal (brand of chlormezanone) and Capfets, trademarks rpg, U. S. Pal. Off. 4716

1. Ganz, S. E.: J. Indiana M
52:1134, July, 1959. 2. Kearney, R
Current Therap. Res. 2:127, /
1960. 3. Lichtman, A. L.: Kent
Acad. Gen. Pract. J. 4:28, Oct.,

Clinical results with IrWlCOpaF

Excellent

Good

Fair

Poor

Total

LOW BACK SYNDROMES

Acute low back strain

25

19

8

6

58

Chronic low back strain

11

5

1

1

18

"Porters' syndrome"*

21

5

1

1

28

Pelvic fractures

2

1

_

mmm

3

NECK SYNDROMES

Whiplash injuries

12

6

2

1

21

Torticollis, chronic

6

2

3

2

13

)THER MUSCLE SPASM

Spasm related to trauma

15

6

1

—

22

Rheumatoid arthritis

—

18

2

1

21

Bursitis

2

6

1

—

9

TENSION STATES

18

2

4

3

27

TOTALS

112

70

23

15

220

(51%)

(32%)

(10%)

(7%)

(100%)

♦Over-reaching in lifting heavy

bags resulting in s

jprain of uppei

, middle, and lower back muscle

5.

Dosage: Adults, 200 or 100 mg. orally three or four times daily.

Relief of symptoms occurs in from fifteen to thirty minutes and lasts from four to six hours.

How Supplied: Trancopal Caplets®

200 mg. (green colored, scored), bottles of 100.
100 mg. ( peach colored, scored ) , bottles of 100.

I l)wtn/ieb

LABORATORIES, New York 1 8, N. Y.

Why diet is preferable to drugs

... in the control of seruii

The objective of therapy is the approxi-
mation of the physiological norm.

This is most satisfactory when it can be accom-
plished by dietary manipulation. The control of
elevated serum cholesterol through relatively sim-
ple changes in the dietary pattern of the patient
puts nature's own processes to work most effec-
tively to achieve the objectives of treatment.

The dietary approach does more than correct the
serum cholesterol problem. Because overweight,
together with improper eating patterns, is so often
involved, the prescription of corrective diet helps
the patient to help himself by establishing sound
nutritional practices.

For the prophylaxis and prevention of hypercho-
lestemia, the dietary approach affords the advan-
tages oi simplicity and economy. Diet therapy is
for the long-term management of a chronic con-
dition, while drug therapy is most efficient for
acute situations.

The development of atherosclerosis is a slow proc-
ess. It is believed that the onset of this condition
is in early adulthood, but its clinical symptoms
take as many as 20 years to manifest themselves.
Simple changes in diet serve to keep the blood
cholesterol concentration at an acceptable level.

Dietary therapy has other significant advantages
over medication as follows:

1. Dietary adjustment involves little or no ex-
pense to the patient, whereas drugs are costly.

2. Dietary therapy may be made with complete
safety — even for pregnant females.

3. Dietary therapy produces no side effects,
whereas there is not as yet sufficient clinical
evidence as to the long-term effects of drugs.

4. Dietary therapy brings about reduction in
serum cholesterol through normal body proc-
esses, as yet not fully understood. On the other
hand, some drugs can leave in the body accu-
mulations of cholesterol precursors.

5. Dietary procedures do not usually generate new
compounds in the blood which interfere with
the chemical determination of blood serum
cholesterol.

6. Dietary therapy offers a solution to the related
problems of obesity which drugs do not.

Elevated serum cholesterol has long been linked
to an imbalance in the ratio of the type of fat in
the diet. Reductions in cholesterol levels have been
achieved repeatedly, both in medical research and
practice, through control of total calories and
through replacement of an appreciable percent-
age of saturated fat by poly-unsaturated vege-
table oil. An important measure in achieving re-
placement is the consistent use of poly-unsaturated
pure vegetable oil in food preparation in place of

saturated fat.

* * *

Poly-unsaturated Wesson is unsurpassed by
any readily available brand, where a vegetable
(salad) oil is medically recommended for a
cholesterol depressant regimen.

ROCK CORNISH GAME HENS — Free Wesson recipes for delicious main dishes, desserts and salad dressings are aval
able foryour patients. Request quantity needed from The Wesson People, Dept. N.210 Baronne St., New Orleans 12, Li

More acceptable to patients. Wesson is preferred for its supreme delicacy
of flavor, increasing the payability of food without adding flavor of its own.
Uniformity you can depend on. Wesson has a polyunsaturated content
better than 50%. Only the lightest' cottonseed oils of high iodine number are
selected for Wesson, and no significant variations are permitted in the 22
exacting specifications required before bottling.
Economy. Wesson is consistently priced lower than the next largest seller.

Wesson's Important Constituents

Wesson is 100% cottonseed oil . . . winterized and of selected quality

Linoleic acid glycerides(poly-unsaturated) 50-55%

Oleic acid glycerides(mono-unsaturated) 16-20%

Total unsaturated 70-75%

Palmitic, stearic and myristicglycerides(saturated) .... 25-30%

Phytosterol (Predominantly beta sitosterol) 0.3-0.5%

Total tocopherols 0.09-0.12%

Never hydrogenated -completely salt free

holesterol

THE ORIGINAL potassium phenethicillin

SYNCILLIN

(phenoxyethyl penicillin potassium)
A dosage form to meet the individual requirements of patients of all ages in home, office, clinic, and hospital :

Syncillin Tablets - 250 mg. (400,000 units) . . . Syncillin Tablets - 125 mg. (200,000 units)
Syncillin for Oral Solution — 60 ml. bottles — when reconstituted, 125 mg. (200,000 units) per 5 ml.
Syncillin Pediatric Drops — 1.5 Gm. bottles. Calibrated dropper delivers 125 mg. (200,000 units)

Complete information on indications, dosage and precautions is included in the circular accompanying each package.

BRISTOL LABORATORIES, SYRACUSE, NEW Y0RK((

Actual case summary

from the files nf

Bristol Laboratories'

Medical Department

ACUTE PHARYNGITIS

SYNCILLIN®

500 mg. t.i.d. - 5 days

W. M. 24-year-old-male. Admitted with sore throat
which had progressed rapidly in severity for 24
hrs. Temp. 104.4. Pulse 110. Acute pharyngitis
and enlarged, red, bulging tonsils covered with
pus. Throat culture revealed beta hemolytic strep.
Patient given 500 mg. SYNCILLIN t.i.d. Within,
24. hrs., fever terminated by crisis with
marked relief of local signs and symptoms.
After 5 days, infection was cured.

^

\>v

:*\A

._

,f#.

~-*V

..^i \>,- Mm

W/A

October, 1960

ADVERTISEMENTS

XIII

SAUNDERS BOOKS

New (12 th) Edition ! — Thoroughly Revised and Up-to-Date

Greenhill- Obstetrics

This beautifully illustrated volume, in a completely re-
vised edition, covers virtually every aspect of obstetrics
from nutritional counseling of the mother in early stages
of pregnancy to pathology of the newborn. Dr. Green-
hill and his collaborators fully explain the mechanisms
of labor plus step-by-step procedures in delivery. Effec-
tive care at every stage is detailed — immediate treatment
of unexpected difficulties; prevention of accident and in-
fection; relief of discomfort; management of various
disease states concurrent with pregnancy. Complications

and pitfalls are well outlined. The authors bring you fuller
understanding of such topics as: Antepartum Care — Tox-
emias of Pregnancy — Abortion — Multiple Pregnancy —
Effects of Labor on the Child — Breech Extraction — Etc.

From the Original Text by Joseph B. DeLee. M.D. By J. P. GREEN-
HILL, M.D. , Senior Attending Obstetrician and Gynecologist. The
Michael Reese Hospital; Obstettician and Gynecologist, Associate
Staff, The Chicago Lying-in Hospital; Attending Gynecologist. Cook
County Hospital; Ptofessot of Gynecology, Cook County Graduate
School of Medicine. With the Assistance of 23 Eminent Collaborators.
1098 pages, 7"xl0", with 1219 illustrations on 903 figures, 119 in
color. S17.00. New (12th) Edition!

A New Book! — Useful Techniques for Interpreting Chest Roentgenograms

Felson-Fundamentals of Chest Roentgenology

This practical text presents a clear introduction to x-ray
diagnosis by demonstrating many useful techniques for
interpreting chest films. It deals primarily with funda-
mentals and considers specific disease entities only for
the purpose of illustrating the principles discussed.
Many beautifully reproduced roentgenograms augment
and illuminate the text discussions. An extensive series
of films of normal chests shows minor deviations from
the normal picture and explains which can be safely ig-
nored. In addition, Dr. Felson includes a separate chap-
ter on special roentgen signs which have important

diagnostic implications. Here you will find The Pul-
monary Meniscus Sign, The Double Lesion Sign, The
Notch Sign.The Butterfly Shadow,TheSail Shadow of the
Thymus, etc. The principles outlined here can be effec-
tively applied to evaluation of films of other body areas.

By BENJAMIN FELSON, MD, Professor and Director, Department
of Radiology, Universiry of Cincinnati College of Medicine; Director,
Department of Radiology, Cincinnati General, Children's, Daniel
Drake, Dunham, Christian R. Holmes, and Longview Hospitals;
Special Consultant, U. S. Public Health Service; Consultant to the
Dayton and Cincinnati Vetetans Administration Hospitals. 301
pages. 6V'2"xlO"1 with 450 illustrations on 23S figures. About
SI 1.00. New — Just Ready!

A New Book! — Management of Today's Industrial Accidents and Hazards

Johnstone & Miller-Occupational Diseases & Industrial Medicine

With increased exposure of the public to toxic materi-
als, more physicians are confronted with situations
closely related to the practice of industrial medicine.
This useful volume compiles all the known information
about occupational disorders — their prevention, diag-
nosis and management. The authors illuminate the full
spectrum of the field from Scope and Elements of Indus-
trial Medical Practice to Diagnosis of Occupational Dis-
eases. The major part of the book is devoted to clear,
concise descriptions of the occupational diseases, utiliz-
ing the clinical approach throughout. Organization log-

ically progresses from etiology, signs and symptoms,
treatment, estimation of permanent and temporary disa-
bility. Treatment is well outlined. Among the injurious
agents covered, you'll find Noxious Gases, Resins and
Plastics, Pesticides, Ionizing Radiations, etc.

By Rutherford T. Johnstone, M. D., Consultant in Industrial
Medicine, Clinical Professor of Preventive Medicine and Public Health
and Clinical Professor of Medicine, University of California at Los
Angeles; and SEWARD E. MILLER. M.D.. Director. Institute of Indus-
trial Health. Professor of Medicine. Medical School. Professor of In-
dustrial Health, School of Public Health. University of Michigan,
Ann Arbor. 482 pages, 6^4 "x9%", illustrated. About $11.50.

New — Just Ready!

Order Today from W. B. SAUNDERS COMPANY

West Washington Square Philadelphia 5

Please send and charge my account:

□ Greenhill's Obstetrics, $17.00.

D Felson's Fundamentals of Chest Roentgenology, about $11.00.

□ Johnstone & Millet's Occupational Diseases and Industrial Medicine, about $1 1.50.

Name

Address

I SJG- 10-60
I

In over five year;

. . . for the tense and nervous patient

Despite the introduction in recent years of "new and different" tranquil-
izers, Miltown continues, quietly and steadfastly, to gain in acceptance.
Meprobamate (Miltown) is prescribed by the medical profession more than
any other tranquilizer in the world.

The reasons are not hard to find. Miltown is a knotvn drug. Its few side
effects have been fully reported. There are no surprises in store for either
the patient or the physician.

of clinical use...

Proven

in more than 750 published clinical studies

Effective

for relief of anxiety and tension

Outstandingly Safe

1 simple dosage schedule produces rapid, reliable
tranquilization without unpredictable excitation

2 no cumulative effects, thus no need for difficult
dosage readjustments

does not produce ataxia, change in appetite or libido

4

does not impair mental efficiency or normal behavior

does not produce depression, Parkinson- like symptoms,
jaundice or agranulocytosis

Milt own;

meprobamate (Wallace)

Usual dosage: One or two 400 mg. tablets t.i.d.

Supplied: -100 mg. scored tablets, 200 mg. sugar-coated tablets;

or as meprotabs*— 400 mg. unmarked, coated tablets.

^* WALLACE LABORATORIES / Cranbury, N. J.

Arterial

representation

adapted from

Recueil de

Planches,

Tome Second,

Chez Pellet

a Geneve, 1779

for more

effective

management

of

edet
ertens:

-an outstanding
SALUTE NSIVE

saluretic and antihypertensive

agent

saLuroN

sustained-action hydroflumethiazide 'Bristol'

as an antihypertensive: "a distinct advantage in the manifestations of hypertension"1

... a superior foundation drug for an antihypertensive regimen . . . often the
only drug required ... in other cases, enhances the effect of tranquilizers,
sympathetic depressants, and ganglionic blockers.

as a saluretic: "a marked advancement in the field of diuretic therapy"2

. . . prompt sodium excretion, with "a duration of at least 18 hours" on a single
50-mg. tablet1. . . repetitively effective.1'3

INDICATIONS: Hypertension and hypertensive cardiovascular disease. Edema, associated with cardiac or
renal insufficiency, hepatic cirrhosis, pregnancy, premenstrual syndrome, or steroid administration.

DOSAGE: Usually 1 tablet daily. Full information in official package circular.

SUPPLY : Scored 50-mg. tablets ; bottles of 50. Syrup, containing 50 mg, per 5-ml. teaspoonf ul ; bottles of 8 fl. oz.

REFERENCES: 1. Ford, R. V., and Nickell, J.: Ant. Med. & Clin. Ther. 6:461, 1959. 2. Fuchs. M.,
and Mallin, S. R.: Int. Rec. Med. 172:438, 1959. 3. Ford, R. V.: Int. Rec. Med. 172:434, 1959.

Bristol

BRISTOL LABORATORIES, SYRACUSE, NEW YORK

It was the introduction of neo Bromth several years ago that created such widespread
interest in the premenstrual syndrome — because of neo Bromth's specific ability
to prevent the development of the condition in the first place.

The action of neo Bromth is not limited merely to control of abnormal water retention,
or of nervousness, or of pain — or any other single or several of the multiple
manifestations characteristic of premenstrual tension, neo Bromth effectively controls
the whole syndrome.

neo Bromth is also completely free from the undesirable side effects associated with
such limited-action therapy as ammonium chloride, hormones, tranquilizers and potent
diuretics, neo Bromth has continued to prove to be the safest — as well as the most
effective — treatment for premenstrual tension.

Each 80 mg. tablet contains 50 mg. Pamabrom, and 30 mg. pyrilamine maleate.
Dosage is 2 tablets twice daily (morning and night) beginning 5 to 7 days before
menstruation. Discontinue when the flow starts.

BRAYTEN PHARMACEUTICAL COMPANY . Chattanooga 9, Tennessee

m

"Sometimes, I almost
wish I were human so
I could clear up this
close-up, clogged-up
nose of mine with
TRIAMINIC*'

ancl f qj. humans Nasal congestion often persists with "bulldog tenacity." Nose drop

and sprays often reach only the more superficial respiratory men
branes and therefore fail to provide adequate relief. Furthermor

CLOGGE D -UP they may ac^ to ^e Patients misery by producing rebound congestio

ciliary inhibition, and eventually "nose drop addiction." TRIAMIN
reaches all nasal and paranasal membranes syst emically — provid
more complete, longer-lasting relief while it avoids the harmful sic
effects associated with topical medication.

Indications: nasal and paranasal congestion, sinusitis, postnasal dri
upper respiratory allergy.

Relief IS prompt and prolonged Each Triaminic timed-release Tablet provides:

of this special timed-release action: ES^110::::::::^^

Pyrilamine maleate 25 mg.

., , Dosaqe: 1 tablet in the morning, midafternoon and at bedtim

r i si — the outer layer . a ,,. ,.,,..,_ j^- • ,, ~ .

jm^± , .... In postnasal drip. I tablel al bedt ■ is usually sufficient.

,4a ■£, dissolves within H *'

L^^^j minutes to produce Each timed-release Triaminic J uvelet® provides:

l"^*\^_y 3 t0 4 hours of relief % the formulation of the Triaminic Tablet.

(/,,„ —the core Dosage: 1 Juvelet in the morning, midafternoon and at bedti

disintegrates to Each tsp ,5 m! j 0f Triaminic Syrup provides:

give 3 to 4 more formulation of the Triaminic Tablet,

hours of relief ™ . . , „

Dosage (to be administered every 3 or 4 hours):

Adults — 1 or 2 tsp.; Children 6 to 12—1 tsp.;

Children 1 to 6 — Vz tsp.; Children under 1 — V* tsp.

X-®

U J /v 1 V jL JL -L^ -L \^ timed-release tablets, juvelets, and syrup
ting noses <£*, ^C, and open stuffed noses orally

after milk and rest, why Donnalate?

Once you've prescribed milk and rest for a peptic ulcer patient, Donnalate
may be the best means for fulfilling his therapeutic regimen. This is because
Donnalate combines several recognized agents which effectively complement
each other and help promote your basic plan for therapy. A single tablet also
simplifies medicine-taking.

Ill EJUIIIIululCa Dihydroxyaluminum aminoacetate affords more con-
sistent neutralization than can diet alone. • Phenobarbital improves the pos-
sibility of your patient's resting as you totd him to. • Belladonna alkaloids
reduce Gl spasm and gastric secretion. And by decreasing gastric peristalsis,
they enable the antacid to remain in the stomach longer.

Each Donnalate tablet equals one Robalate® tablet plus one-half Donnatal®
tablet: Dihydroxyaluminum aminoacetate, N. F., 0.5 Gm.; Phenobarbital (%
gr.), 8.1 mg.; Hyoscyamine sulfate, 0.0519 mg.; Atropine sulfate, 0.0097
mg.; Hyoscine hydrobromide, 0.0033 mg.

J A. H.Robins Co. inc

>/? RICHMOND 20, VIRGINIA

Donnalate

>

■ "•

In active people who won't take time to eat properly, mvaukc can help prevent deficiencies by

providing comprehensive vitamin-mineral support. Just one capsule a day supplies therapeutic

closes of 9 important vitamins plus significant quantities of 11 essential minerals and trace

elements, myadec is also valuable in vitamin depletion and stress states, in convalescence, in

chronic disorders, in patients on salt-restricted diets, or wherever therapeutic vitamin-mineral

supplementation is indicated.

Each myadec Capsule contains: vitamins: Vitamin B,- crystalline- 5 meg.; Vitamin B2 (riboflavin)- 10 mg.;
Vitamin B„ (pyricloxine hydrochloride) - 2 mg.; Vitamin B, mononitrate- 10 mg.; Nicotinamide (niacinamide) -
100 mg.; Vitamin C (ascorbic acid)-150 mg.; Vitamin A-(7.5 mg.) 25,000 units; Vitamin D-(25 meg.) 1,000
units: Vitamin E (d-alpha-tocopheryl acetate concentrate) -5 I.U. minerals: (as inorganic salts) Iodine-0.15 mg.;
Manganese- 1 mg.; Cobalt-0.1 mg.; Potassium-5 mg.; Molybdenum-0.2 mg.; Iron- 15 mg.; Copper- 1 mg.;
Zinc— 1.5 mg.; Magnesium-6 mg.: Calcium- 105 mg.; Phosphorus— 80 mg. Bottles of 30, 100 and 250.

a quick bite",
then back
to the grind ?
nutritional
deficiency's
not far behind,
prescribe...

high potency vitamin-mineral supplement

PARKE-DAVIS

PARKE. DAVIS & COMPANY

Detroit 32, Michigan

*"%

Raise the Pain Threshold

MAXIMUM SAFE ANALGESI

• •*©•••••••••••••••••••••>;• ® *

PHENAPHEN with CODEINE*

R>bins

A. H. ROBINS CO., INC., RICHMOND 20, VIRGINIA
Ethical Pharmaceuticals of Merit since 1878

XXII

NORTH CAROLINA .MEDICAL JOURNAL

October. lSliiO

To the relief of musculoskeletal pain,

new MEDAPRIN*

adds restoration of function

Analgesics offer temporary relief of musculo-
skeletal pain, but they merely mask pain rather
than getting at its cause. New Medaprin, in
addition to bringing about prompt subjective
improvement, promotes the restoration of normal
function by suppressing the inflammation that
causes the pain.

Medaprin. Upjohn's new analgesic-steroid com-
bination, contains aspirin plus Medrol,** the
corticosteroid with the best therapeutic ratio in
the steroid field.'' Instead of suffering recurrent
discomfort because of the "wearing off" of
analgesics, the patient on Medaprin experiences
a smooth, extended relief and more normal
mobility.

Indications: Medaprin is indicated in mild-to-
moderate rheumatic and musculoskeletal condi-

tions, including rheumatoid arthritis, deltoid
bursitis, low back pain, neuralgia, synovitis,
fibromyositis. osteoarthritis, low back sprain,
traumatic wrist, sciatica, and "tennis elbow."
Dosage: The recommended dosage is 1 tablet
q.i.d. The usual cautions and contraindications
of corticotherapy should be observed.
Supplied: In bottles of 100 and 500.
Formula: Each Medaprin tablet contains

• 300 mg. acetylsalicylic acid, for prompt
relief nf pain

• 1 nig. Medrol, to suppress the causative
inflammation

• 200 mg. calcium carbonate, as buffer

'TRADEMARK * TRADEMARK, REG. U.S. PAT. OFF. — METHYLPRECN ISOLONE, UPJOHN
tRATIO OF DESIRED EFFECTS TO UNOESIRED EFFECTS

- Company. Kalamazo:

Upjohn

October, 1960

ADVERTISEMENTS

XXIII

ALL OVER AMERICA!

KENTwiththe MICRONITE FILTER

IS SMOKED BY
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than any other cigarette!*

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The rich pleasure of smoking
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Ci«Q.cLoeiiAii>ca

XXIV

NORTH CAROLINA MEDICAL JOURNAL

October, 1960

YEARS

senile
anxiety

disorientation

agitation

hostility

irritability

apprehension

hysteria

insomnia

chronic

urticaria

alcoholism

menopausal

syndrome

neuro-
dermatoses

functional

gastrointestinal

disorders

psychoneuroses

tension
headaches

dysmenorrhea

psychosomatic
complaints

situational
stress

asthma

hyperactivity

tics

preoperative
anxiety

enuresis
behavior
problems

ATARAX ENCOMPASSES MORE PATIENT NEEDS... LETS YOU
CHART A SAFER, MORE EFFECTIVE COURSE TO TRANQUILITY

atar<\x has a wide range of flexibility . . . from
mild adult tensions and.anxieties to full-blown
alcoholic episodes . . . from the behavior dis-
orders of childhood to the emotional problems
of old age. Why? Because it gives you maximum
adaptability of dosage . . . works quickly and
predictably ... is unsurpassed in safety.

Atarax offers extra pharmacologic actions
especially useful in certain troublesome con-
ditions. It is antihistaminic and mildly anti-
arrhythmic, does not stimulate gastric secre-
tions. Hence it is well suited to the needs of
your allergic, cardiac and ulcer patients.

Have you discovered all the benefits of

ATARAX?

Dosage: Adults, one 25 mg. tablet, or one tbsp. Syrup
q.i.d. Children, 3-6 years, one 10 mg. tablet or one tsp.
Syrup t.i.d.; over 6 years, two 10 mg. tablets or two tsp.
Syrup t.i.d.

Supplied: Tiny 10 mg., 25 mg., and 100 mg. tablets, bot-
tles of 100. Syrup, pint bottles. Parenteral Solution:
25 mg./cc. in 10 cc. multiple-dose vials: 50 mg./cc. in
2 cc. ampules. Prescription only.

Complete bibliography available on request.

ATARAX

(BRAND OF HYDROXYZINE)

PASSPORT TO TRANQUILITY

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a

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it calms anxiety. . . rapidly and safely

Balances the mood — no "seesaw" effect
of amphetamine -barbiturates and ener-
gizers. While amphetamines and energizers may
stimulate the patient — they often aggravate
anxiety and tension.

And although amphetamine-barbiturate combina-
tions may counteract excessive stimulation — they
often deepen depression.

In contrast to such "seesaw" effects, Deprol's
smooth, balanced action lifts depression as it calms
anxiety — both at the same time.

Dosage: Usual starting dose is 1 tablet
q.i.d. When necessary, this dose may be grad-
ually increased up to 3 tablets q.i.d.

Composition: 1 mg. 2-diethylaminoethyl benzi-
late hydrochloride (benactyzine HC1) and 400 mg.
meprobamate. Supplied: Bottles of 50 light-pink,
scored tablets. Write for literature and samples.

Acts swiftly— the patient often feels
better, sleeps better, within a few days.

Unlike the delayed action of most other antide-
pressant drugs, which may take two to six weeks
to bring results, Deproi relieves the patient quickly
—often within a few days. Thus, the expense to the
patient of long-term drug therapy can be avoided.

Acts safely — no danger of liver damage.

Deproi does not produce liver damage, hypoten-
sion, psychotic reactions or changes in sexual
function — frequently reported with other anti-
depressant drugs.

ADeprol

A®

WALLACE LABORATORIES/ Cranbury, N.J.

XXVI NORTH CAROLINA MEDICAL JOURNAL October, I960

WHEN ULCEROGENIC FACTORS KEEP ON WORKING...

October, 1960

ADVERTISEMENTS

XXVII

REMEMBER THIS: SO DOES ENARAX

Think of your patient with peptic ulcer— or with gastrointestinal
dysfunction — on a typical day.

Think of the anxieties, the tensions.

Think, too, of the night: the state of his stomach emptied of food.

Disturbing?

Then think of enarax. For enarax was formulated to help you control pre-
cisely this clinical picture, enarax provides oxyphencyclimine, the in-
herently long-acting anticholinergic (up to 9 hours of actual achlorhydria1)
. . . plus Atarax, the tranquilizer that doesn't stimulate gastric secretion.

Thus, with b.i.d. dosage, you provide continuous antisecretory/antispas-
modic action and safely alleviate anxiety . . . with these results: enarax
has been proved effective in 92% of G.I. patients.2-4

When ulcerogenic factors seem to work against you, let enarax work
/or you.

ENARAX ;

(lO MG.OXYPHENCYCLIMINE PLUS 25 MG. ATARAX®t) A SENTRY FOR THE G.I TRACT

dosage: Begin with one-half tablet b.i.d. - preferably in the morning and before retiring.
Increase dosage to one tablet b.i.d. if necessary, and adjust maintenance dose according
to therapeutic response. Use with caution in patients with prostatic hypertrophy and only
with ophthalmological supervision in glaucoma.

supplied: In bottles of 60 black-and-white scored tablets. Prescription only.

References: 1. Steigmann, F., et a!.: Am. J. Gastroenterol. 33:109 (Jan.) 1960. 2. Hock, C. W.:
to be published. 3. Leming, B. H., Jr.: Clin. Med. 6:423 (Mar.) 1959. 4. Data in Roerig Medical

Department Files. fbrand of hydroxyzine

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October, 1960

ADVERTISEMENTS

XXIX

inner
protection

am

to

contain

the

bacteria-prone

cold

(Triacetyloleandomycin, Triaminic® and CalurinS

safe antibiosis

Triacetyloleandomycin, equivalent to oleandomycin
125 mg. This is the URI antibiotic, clinically effective
against certain antibiotic-resistant organisms.

fast decongestion

Triaminic5, 25 mg., three active components stop run-
ning noses. Relief starts in minutes, lasts for hours.

well-tolerated analgesia

Calurin®, calcium acetylsalicylate carbamide equivalent
to aspirin 300 mg. This is the freely-soluble calcium
aspirin that minimizes local irritation, chemical erosion,
gastric damage. High, fast blood levels.

Tain brings quick, symptomatic relief of the common
cold (malaise, headache, muscular cramps, aches and
pains) especially when susceptible organisms are likely
to cause secondary infection. Usual adult dose is 2 Inlay-
Tabs, q.i.d. In bottles of 50. If only. Remember, to con-
tain the bacteria-prone cold... TAIN.

SMITH-DORSEY • LINCOLN, NEBRASKA

a division of The Wander Company

XXX

NORTH CAROLINA MEDICAL JOURNAL

October, 1960

• increases bile

Dechotyl stimulates -J

the flow of bile— _

a natural bowel
regulator

• improves motility

Dechotyl gently stimulates

intestinal peristalsis

• softens feces

Dechotyl expedites fluid

penetration into bowel contents

helps free your patient from both...
constipation and laxatives

DECHOTYL

TRABLETS*

well tolerated... gentle transition to normal bowel function
Recommended to help convert the patient-naturally and gradually— to healthy
bowel habits. Regimens of one week or more are suggested to assure mainte-
nance of normal rhythm and to avoid the repetition of either laxative abuse or
constipation.

Average adult dose: Two Trablets at bedtime as needed or as directed by a physician.
Action usually is gradual, and some patients may need 1 or 2 Trablets 3 or 4 times daily.

Contraindications: Biliary tract obstruction; acute hepatitis.

Dechotyl Trablets provide 200 mg. Decholin.S (dehydrocholic acid, Ames), 50 mg.
desoxycholic acid, and 50 mg. dioctyl sodium sulfosuccinate, in each trapezoid-shapcd,
yellow Trablet. Bottles of 100.

•Ames t.m. for trapezoid-shaped tablet. emo

AMES

COMPANY. INC
Elkhort . Indiono
Toronto • Conoda

"Sometimes,
when I have
a running nose,
I'd like to
clear it with

TRIAMINIC^

just to check out
that systemic
absorption business.

Reaches all nasal
and paranasal
membranes, huh?"

. . . and for humans

with

RUNNING NOSES

You can't reach the entire nasal and paranasal mucosa by putting
medication in a man's nostrils — any more than you could by trying to
pour it down an elephant's trunk. TRIAMINIC, by contrast, reaches all
respiratory membranes systemically to provide more effective, longer-
lasting relief. And TRIAMINIC avoids topical medication hazards such
as ciliary inhibition, rebound congestion, and "nose drop addiction."

Indications: nasal and paranasal congestion, sinusitis, postnasal drip,
upper respiratory allergy.

Relief is prompt and prolonged

because of this special timed-release action:

first" the outer layer
dissolves within
minutes to produce
3 to 4 hours of relief

then — the core
disintegrates to
give 3 to 4 more
hours of relief

TRIAMINIC

Each Triaminic timed-release Tablet provides:

Phenylpropanolamine HC1 50 mg.

Pheniramine maleate 25 mg.

Pyrilamine maleate 25 mg.

Dosage: 1 tablet in the morning, midafternoon and at bedtime.
In postnasal drip. 1 tablet at bedtime is usually sufficient.

Each timed-release Triaminic Juvelet® provides:

l/2 the formulation of the Triaminic Tablet.
Dosage: 1 Juvelet in the morning, midafternoon and at bedtime.

Each tsp. (5 ml.) of Triaminic Syrup provides:

Vi the formulation of the Triaminic Tablet.
Dosage (to be administered every 3 or 4 hours) :

Adults — 1 or 2 tsp.; Children 6 to 12— 1 tsp.;

Children 1 to 6 — Y2 tsp.; Children under 1 — V& tsp.

timed-release tablets, juvelets, and syrup
running noses ^%, 0i*i and open stuffed noses orally

SMITH-DORS EY • a division of The Wander Company • Lincoln, Nebraska

XXXII

NORTH CAROLINA MEDICAL JOURNAL

October, 1960

<£?«%

. . . DARVO-TRAN" relieves pain more effectively than

the analgesic components alone

Effective analgesia plus safe relief of mild anxiety helps combat the pain-
anxiety spiral. In Darvo-Tran, the tranquillizing properties of Ultran® are
added to the established analgesic effects of Darvon® and the anti-inflam-
matory benefits of A.S.A.®. Clinical and pharmacologic studies have shown
that when pain is accompanied by anxiety, the addition of Ultran enhances
and prolongs the analgesic effects of Darvon.

Each Pulvule® Darvo-Tran provides:

Darvon .... 32 mg. — to raise pain threshold

A.S.A 325 mg. — to reduce inflammation

Ultran 150 mg. — to relieve anxiety

Usual Dosage:

1 or 2 Pulvules three or four times daily.

Darvo-Tran™ (dextro propoxyphene and
acetylsalicylic acid with phenaglycodol,
Lilly)

Ultran® (phenaglycodol, Lilly)

Darvon® (dextro propoxyphene hydrochloride.
Lilly)

A.S.A.® (acetylsalicylic acid, Lilly)

ELI LILLY AND COMPANY

INDIANAPOLIS 6,

INDIANA, U.S.A.

020407

North Carolina Medical Journal

Owned and Published by
The Medical Society of the State of North Carolina

Volume 21

October, 1960

No. 10

Problems of Adjustment of Gifted Children

Cornelius Lansing, M.D.
Chapel Hill

Why should we concern ourselves with
the adjustment problem of gifted children?
Smart as they are, can't they take care of
themselves? I am glad to say that the vast
majority do turn out all right, and their su-
perior mental capacity does seem to be a
help in their adjustment to the critical
problems of growing up, and in meeting un-
usual life situations. Nevertheless, they do
not lack for problems. They are no more
immune to the everyday problems of grow-
ing up than to measles and mumps. Entire-
ly apart from causing unhappiness, serious
emotional problems can cripple the pro-
gress, efficiency, and productiveness of a
gifted child just as surely as can poverty,
lack of opportunity, or shortsighted, un-
sympathetic educational management. In
some cases, the effects can be even more de-
vastating.

Changing Attitudes

In centuries past, youngsters of unusual
talent were regarded with a kind of super-
stitious awe; when they were recognized,
people did the best they could for them,
such as putting them under the patronage
of a wealthy or powerful person, where they
could be appropriately educated, and might
eventually continue in the service of the
patron, as sort of scholastic artisans. There
is no telling how many were lost from lack
of recognition, or were held down by the
rigid social structure. In any case, very
little notice was paid to adjustment prob-
lems. Those who were ambitious and could
make the grade did well ; others fell by the
wayside and were forgotten.

Around 1850, before the dawn of modern
psychology, people came to believe that gen-

Kead before the Sixth Annual Conference on Children with
Special Needs, sponsored by the North Carolina Health Coun-
cil, Durham, February 25, 26, 1960.

From the Department of Psychiatry, University of North
Carolina School of Medicine, Chapel Hill.

ius and insanity were closelv linked. Also,
if you were an artist or a literary man, it
was quite fashionable to have tuberculosis.
Lord Byron is said to have earnestly de-
sired to be consumptive, like some of his
famous colleagues. This seems ridiculous,
but there may have been a grain of sense in
it. In poetic and other artistic endeavors,
where imagery and creative imagination
are at a premium, the changing moods of
depression and elation were perhaps useful
to some ; and fever, like alcohol, served to
release the imagination from humdrum,
everyday thought patterns. It may be that
ways of thinking were so rigidly stereo-
typed in those days that the only way for
some people to break the chains was to be a
little mad or a little sick.

Unfortunately, however, this attitude led
to the notion that men of genius were ab-
normal, unstable, and headed for insanity
or deterioration. This in turn led to a fear
that precocity would be disastrous to a
child, so that parents of gifted children
were careful to protect them from stimula-
tion, and discouraged them from manifest-
ing early cleverness. An altogether un-
founded myth was circulated that many
great geniuses were dunces in childhood.
Perhaps we should be charitable with the
authors of all this nonsense, and those who
accepted it. Fear and jealousy are powerful
emotions, and not too long before, eccen-
trics were burned at the stake as witches.
Only Francis Galon managed to steer
clear of this romantic emotionalism, and
took the trouble to study objectively the
lives of famous men, thus setting the stage
for scientific research as an alternative to
misty speculation.

Objective Studies

The first studies, like those of Galton,
were mostly retrospective appraisals of

442

NORTH CAROLINA MEDICAL JOURNAL

October, I960

people who had already achieved eminence.
One reason why difficulties seem to occur
quite often among- famous men, is that
famous men are the ones who have biogra-
phies written, while commonplace people
do not. We also know of child prodigies who
have "burned out" young, beccme mentally
ill, or rebelliously refused to use their tal-
ents constructively. But eminent success is
a lopsided basis on which to select subjects
for research, and the study of notable fail-
ures certainly does not give a valid idea of
what average people or "average" geniuses
are like.

With the development of psychologic tests
and measurements in the latter part of the
nineteenth century, and the Binet -Simon
Scab for Children in 1905, it becam • possi-
ble to identify gifted people in childhood,
to observe them on the snot, so to speak, and
to follow them forward, to see what became
of them. Nearly 40 years ago Lewis M. Ter-
man and his co-workers began their mon-
umental work of studying and following
more than a thousand gifted children. Their
study has the tremendous advantage of hav-
ing selected its subjects from a large and
presumably normal or average school popu-
lation. All the children they could locate
with an intelligence quotient of 140 or over
were mcluded. This is about 1 per cent of
the total population.

To get a completely representative sam-
ple of a thousand, it would have been neces-
sary to administer 100,000 intelligence tests,
and this was of course not possible. Instead,
the children were identified within a group
of more workable size, in wdiich individuals
were nominated by their teachers as the
brightest or the youngest in the class. In-
terestingly enough, there was a higher pro-
portion of eligible children among those
nominated because they were young than
among those who had impressed the teachers
as being most intelligent. The important
point is that most of these children were
not at the time exceedingly remarkable, as
would have been the case if only children
of outstanding achievement had been se-
lected.

In the initial study, a large group of chil-
dren of average intelligence were similarly
investigated, for comparison. Studies of
single individuals give us insight into the
lives of those particular individuals, but it
is only by studying well selected groups

that we can reliably draw general conclu-
sions and make predictions about other in-
dividuals or groups. In my opinion, this sort
of study provides an adequate basis on
which to make valid judgments about what
gifted children are actually like, and to find
out, in a scientifically meaningful way,
what becomes of them.

Characteristics of the Gifted Child
Popular notion

What is a gifted child really like? When
a cartoonist wishes to portray such a child,
he generally draws a picture of a small,
spindly boy with a bulging forehead, scowl-
ing behind heavy-rimmed glasses, and car-
rying a stack of learned books. The boy may
be looking at a butterfiy with a magnifying
glass or operating an impressive and rather
menacing collection of scientific apparatus.
If he is talking, he uses large, unnecessarily
complicated words, and displays a haughty,
snobbish and scornful attitude toward other
children and adults. The "girl genius" is
shown as less malicious, but no less unat-
tractive — dowdy and unfeminine, aggress-
ively impertinent, or else alone in the re-
cesses of a library, wearing even bigger and
more repulsive glasses than the boy.

I hope I need not tell you that very few
children are like this caricature, and those
few are probably pretty sick. But there is
always a good deal of hidden truth in hu-
mor, and although this picture is an in-
credible distortion of what the average
gifted child is really like, I think it does
accurately portray some quite common
fears and fantasies which adults have about
gifted children. Confronted with the aver-
age gifted child, who is healthy, happy, and
pretty easy to get along with, this carica-
ture is quickly found to be as unrealistic as
the old-fashioned melodrama villain, with
his top hat, large chin and long black mus-
tache. But I think that a great many par-
ents do have a lurking fear that they might
be dealing with a monster, a misshapen,
sickly, sexually distorted, priggish and
downright nasty individual, mischievous and
vengeful, and possessing frightening in-
tellectual powers with which to carry out
his devilish schemes. It is apparent that
superstitious awe did not entirely die out in
the Middle Ages, and that there is plenty of
need, even in this era of enlightenment, to
let people know what gifted children are
actually like.

October, 1960

GIFTED CHILDREN— LANSING

443

Terman studies

The initial Terman study showed that,
compared to a similar group of average
children, their gifted subjects were healthier
and more robust, were in general better
adjusted as individuals, and were equally
popular socially. They were a good deal
more interested in reading, on a wide va-
riety of subjects, and did in fact spend more
time alone than the average, and less in
groups. However, their social maturity was
at least as good as average, despite the fact
that they were younger than their asso-
ciates; and, although they spent less time
actually playing group games, they were
familiar with more different kinds of chil-
dren's games than the group to which they
were compared. Although they were of
co-.rse way ahead in school performance,
they were less adept than their peers in
penmanship and shopwork, perhaps because
their interest in intellectual skills and ab-
stract problems far outweighed their moti-
vation to perfect manual skills. In routine
scholastic exerises like a simple arithmetic
drill, their performance was not up to their
over-all capacity; gifted children have little
need of repetitive practice once they have
clearly understood the general principle,
and they find this sort of thing tedious and
boring.

Incidence of maladjustment

Adjustment is a tricky thing to assess,
because nobody can agree on just what good
adjustment is. From my point of view as a
child psychiatrist, the Terman studies are
handicapped by the lack of formal psychia-
tric appraisal. However, there is pretty gen-
eral agreement on many items of poor ad-
justment, and I think it fair to say, from
the long-term follow-ups, that the record of
adjustment of gifted children is at least as
good as that of the average population, and
probably a good deal better. After 18 years,
80 per cent of those responding to question-
naires rated themselves as having satisfac-
tory general adjustment. Fifteen per cent
had had some difficulties, and 4 per cent
had had serious difficulties at some time.
One per cent had been psychotic at some
time. Five of the men and 2 women had
committed suicide. Eleven men and 6 women
were homosexual. Three of the boys had
been to reform school, but had made out

all right afterward. One man as an adult
was in prison for forgery. Four or 5 women
had had illegitimate children.

The foregoing figures give an idea of the
incidence of some of the more important
difficulties, which in my opinion is remark-
ably low. The men tended to marry earlier
than average, and the women later, but by
1946 more of both were married than in an
average population. The divorce rate was
about average. On the positive side, of
course, the record of achievement is most
impressive, but cannot be outlined here.
Thus I think it is fair to say that the en-
dowments which lead to superior scholastic
achievement also lead to adequate personal
and social adjustment, and although diffi-
culties do arise, they are no more common
than among average people. There is evi-
dence that when gifted people do have emo-
tional difficulties, they are able to resolve
them to an unusual degree. In the Terman
study, all the notable failures seemed to
come from seriously disturbed home envi-
ronments.

Types of Problems Encountered

What actual difficulties do occur? The
symptoms are not much different from
those of ordinary children. Common mani-
festations are anxiety, poor school work,
nailbiting, bedwetting, nightmares, exces-
sive daydreaming, social withdrawal, fear-
fulness and actual phobias, and various be-
havioral disturbances such as undue ag-
gressiveness, temper tantrums, stubbornness,
rebelliousness, mannerisms, and ritualistic
behavior. Because of their special abilities,
such children when disturbed may also ex-
hibit behavior which is uncommon in aver-
age children. If they have a strong need for
attention, they are able to dominate the
center of the stage with witty and clever
remarks. They may be smart-alecky and
verbally aggressive, rather than physically
aggressive. It is easy enough for us to see
that fearfulness indicates emotional dis-
tress. It may be a little more difficult to un-
derstand that a nagging, bossy, obnoxious
child may also be unhappy and in need of
help.

Contributing factors

What lies behind these symptoms? Al-
though it would be tempting to say that
jealousy and lack of understanding on the

444

NORTH CAROLINA MEDICAL JOURNAL

October, 1960

part of associates, the school, and the com-
munity as a whole is the principal cause of
maladjustment in these children, it is safer
to suppose that the root of the difficulty is
within the home. Certainly bullying, teas-
ing and antagonistic attitudes on the part
of less gifted peers or teachers may at
times give rise to quite justified anger, un-
happiness, and frustration. The ups and
downs of social existence however, are far
less important to children, particularly
young children, than attitudes and relation-
ships within the family. Being a parent is
a pretty taxing job under the best of cir-
cumstances, and people with fairly serious
neurotic or personality problems of their
own may find it very difficult to meet the
emotional needs of their children. In some
cases, parents wish their gifted children to
make up for some of their own failures in
life, and this may lead to quite unreason-
able demands for maturity and scholastic-
success. When a child is able to talk and
think like an adult, it is all too easy to ex-
pect him to have the feelings and stability
of an adult, and to be surprised or angry
when he behaves childishly. In addition,
illness, birth of siblings, sickness or death
within the family, and general human mis-
fortunes are problems which must at times
be dealt with, and which obviously put some
strain on the youngster's adaptive capaci-
ties. All these things may be reflected in
disturbances of behavior or performance.
In addition, virtually all children manifest
some form of rebellion during adolescence,
which may result in poor school or social
performance, or general uncooperativeness.

I will give some examples of parent-child
problems from a child guidance clinic in
Boston. These gifted children were brought
to the clinic because they were antagonistic,
or seclusive and shy, or doing poorly in
school. In 7 cases the parents gratified their
own vanity by boasting about the child,
without much regard to his own needs ; they
regarded the children as extensions of them-
selves, not as individuals in their own right.
In 11 cases the children were pushed and
overstimulated; this is the sort of thing
which you sometimes see with child prodi-
gies, where the child's powers are being ex-
ploited for social or financial gain. Fifteen
parents were possessive and overprotective,
which led to an excessively close relation-
ship between parent and child, to the detri-

ment of normal social relationships. In 7
cases the parents were afraid of the child's
power to outwit and control them, so that
they gave in and let the child "rule the
roost." In 7 other cases, perhaps also moti-
vated by fear, the parents attempted forci-
ble repression of the child's precocity,
which led to mutiny, conflict, and antagon-
ism.

Special Problems of the Gifted Child

The problems I have described can occur
with any children, including gifted ones.
But what are the special problems or dan-
gers to which the gifted child is exposed?
Given a reasonably favorable home envi-
ronment and reasonably mature parents (and
this is generally the case), exploitation,
fear, and hostility from the family are not
too likely to occur. Excessive expectation is
probably the trap into which parents and
teachers fall most easily. The more con-
sistently a person performs, the more log-
ical it is to assume that he will always per-
form consistently. Slumps and doldrums
should be accepted sympathetically, but
when they come as a surprise, may be met
with anger or alarm. There is also a danger
that a bright child may use his intellectual
talents to compensate for certain deficien-
cies of personality, thus sidestepping the
problem instead of facing and resolving it.

In a small school a gifted child may lack
adequate competition, a situation which not
only permits slipshod working habits and a
general lackadaisical attitude towards form-
al learning, but also robs him of early con-
tact with the experience of being second
best. I do not subscribe to the view that
bright children should be "put in their
place" or "taken down a peg," but when
they reach college many are quite dismayed
to face, for the first time, the fact that there
are others who can do quite a bit better. I
need hardly mention the problem of a bright
child who is bored in school because so much
of the work is too simple for him. I might
mention that in the Terman study, most of
the children were two grades ahead of their
age mates, but were actually capable of do-
ing work two grades higher still.

This brings us to the most unique problem
of the gifted child, the fact that scholastic
advancement inevitably produces some so-

October, 1960

GIFTED CHILDREN— LANSING

445

cial dislocation. I feel personally that it is
probably unwise for a 12 year old to enter
college. It would be equally absurd to force
a socially mature gifted child to wait until
he was 17. But I cannot readily say where
the line should be drawn, and I think this
can only be decided by carefully considering
the merits of the individual case. The Ter-
man studies show that it is perfectly possi-
ble for a child to operate happily and suc-
cessfully, even though he is 4 years younger
than his classmates. Certainly an entirely
satisfactory adjustment has been made in
many cases, although I think it is obvious
that an emotionally immature child, or one
with more than average adjustment prob-
lems, could get into a lot of trouble, with
regard to his personality formation. As the
youngest in the class, he finds it easy to
maintain a babyish way of relating to peo-
ple, especially if growing up seems like a
pretty hard job anyway. Certainly these
unusually young children, like children
whose physical growth has been retarded
through disease, are often subjected to a lot
of babying from their classmates. A teacher
can help by applying some restraint to the
enthusiasm of the "little mothers" who
want to make a baby or a pet out of such a
youngster.

The highly gifted

I should like to say a few words about
the problems of the most highly gifted
children, although I have little comfort or
advice to offer. Children with intelligent
quotients of 180 or above are as much ad-
vanced above the "ordinary" gifted child
as the latter is above the average. These
people are exceedingly rare, perhaps 1 in
4000. Although they do not get into obvious
or serious difficulties, it is hard for more
ordinary people to understand them, and
they do have genuine problems in social ad-
justment. They do not, however, demon-
strate antisocial behavior. In childhood, the
problem seems to stem from the divergence
of their interests from those of their age-
mates, and they literally do not "speak the
same language." They tend to develop adult-
sized speaking vocabularies very young,
and it may require considerable effort for
them to keep their language within limits
which can be understood by their friends.
Society often seems less interesting to them
than books, so that they tend to be solitary,

though not necessarily lonely. Perhaps the
real difficulty is that they must learn to
understand and tolerate the slower mental
processes of ordinary children and adults.
I think their most serious handicap is the
lack of companionship of people like them-
selves. One way to understand yourself is
to get to know somebody who thinks the
way you do, and these unusually gifted chil-
dren certainly do not commonly have this
opportunity. This is perhaps the best argu-
ment in favor of sending them to special
schools, where a number of them can get
together to experience more normal peer
relationships. At the same time, of course,
there is an enormous need for basic re-
search in this area, so that the less gifted
but more numerous people, such as our-
selves, may humbly learn how to help these
remarkable children to fulfill the potential
of their priceless gifts, for themselves and
for humanity.

References

1. Galton, F. : Hereditary Genius, New York, The Macmil-
]an Company, 1914. (Original edition, London, 1869)

2. Hollingworth, L. S.: Children Above 180 I.Q.: Origin and
Development, Yonkers-on-Hudson, New York, World Book
Company, 1942.

3. Kanner, L. : Emotional Interference with Intellectual
Functioning. Am. J. Ment. Deficiency 56:701-707, 1952.

4. Strang, R. : Psychology of Gifted Children and Youth,
in Cruickshank, W. M. (ed. ): Psychology of Exceptional
Children and Youth, Englewood Cliffs, New Jersey, Pren-
tice-Hall, Inc.. 1955.

5. (a) Terman, L. M., and others: Mental and Physical
Traits of a Thousand Gifted Children: Genetic Studies of
Genius, vol. 1, Stanford, California, Stanford University
Press, 1925. (b) Cox, C M.: The Early Mental Traits of
Three Hundred Geniuses. Genetic Studies of Genius: vol.
2, ed., Terman, L. M., Stanford, California, Stanford Uni-
versity Press, 1926. (c) Burks, B. S., Jensen, D. W„ Ter-
man, L. M., and others: The Promise of Youth: Follow-
Up Studies of One Thousand Gifted Children, Genetic
Studies of Genius, vol. 3, Stanford, California, Stanford
University Press, 1930. (d) Terman, L. M., Oden. M. H.,
and others: The Gifted Child Grows Up: Twenty-Five
Years' Follow-Up of a Superior Group, Genetic Studies

of Genius, vol. 4, Stanford, California, Stanford Univer-
sity Press. 1947. (e) Terman, L. M.. Oden, M. H., and
others: The Gifted Group at Mid-Life: Thirty-Five Years'
Follow-Up of the Superior Child, Genetic Studies of
Genius, vol. 5, Stanford, California, Stanford University
Press. 1960.

6. Thorn, D. A., and Newell, N.: Hazards of the High I.Q.,
Ment. Hyg. 29:61-77 (Jan.) 1945.

44(5

NORTH CAROLINA MEDICAL JOURNAL

October, 1960

A Follow-Up Study of Premature Infants
Born in Wake County, 1948-1951

A Preliminary Report

ISA C. Grant, M.D., M.P.H.*

cuid

Ellen J. Preston, M.D., M.P.H.f

Raleigh

This report concerns a study of prema-
ture infants born in Wake County between
October 1, 1948, and October 31, 1951, as
compared with a control group of full-term
infants (group 1). The premature infants
were divided into two groups (2 and 3).
Group 2 included those not cared for under
the premature infant program, and group
3 consisted of those who were cared for un-
der the program. The infants in group 1
were matched by birth certificates with cer-
tain factors of the two groups of premature
infants. In making final comparisons, groups
2 and 3 were combined. There were two
reasons for this combination: (1) because
we had failed to take into consideration the
number of children in all groups who had
expired; and (2) so that we could more eas-
ily appraise the differences between the
full-term and premature groups. This made
slight differences in matching characteris-
tics, which will be referred to later. There
were 92 full-term and 137 premature in-
fants in the final comparisons.

Objective and History

In the beginning the object of the study
was to compare the growth and develop-
ment of premature and full-term infants
who were Wake County residents.

In 1948 the North Carolina State Board
of Health established seven centers for the
care of premature infants over the state.
Those born in Wake County who came un-
der the premature program were cared for
either at Rex Hospital in Raleigh, or at
Watts or Duke Hospitals in Durham. Some
of these children are no longer in the coun-
ty, but some of them were easily traced. The
idea for a follow-up study originated in the
State Board of Health. Consultants in the
Maternal and Child Health Section there
visited the Wake County Health Depart-

From the Wake County Health Department, Raleiirh, North
Carolina.

•Health Director.
^Assistant Health Director.

ment, and together they laid plans for the
study.

Beginning in the fall of 1957, a pilot
study was made by the Nursing Division of
the Wake County Health Department. One
hundred thirty-seven families who had had
premature infants cared for under the pro-
gram were visited by the public health
nurses. One and in some instances both
parents were interviewed concerning the
child's development, and teachers were con-
sulted regarding his progress and emotion-
al adjustment in school.

It was found from this superficial obser-
vation that 46, or 33.6 per cent of the chil-
dren had a "defect."* This figure does not
include the additional number who moved
from the state and from whom we had his-
tories of previous defects, or those who died
in premature centers. On the basis of this
finding, the Maternal and Child Health Sec-
tion of the State Board of Health and the
Wake County Health Department decided
to institute a major study, with profession-
al assistance and a comparable control
group.
Organization of Committee

A committee to formulate objectives, se-
lect the sample, and set policies and proce-
dures was organized. It consisted of the
following consultants from the State Board
of Health: Dr. A. H. Elliot, director of the
Personal Health Division; Dr. Charles Wil-
liams, pediatrician ; Dr. James Donnelly,
obstetrician ; Miss Rebecca Swindell, ma-
ternal and child health nurse; Miss Eileen
Kiernan, pediatric nurse; Dr. Ralph McGill,
psychologist; Miss Katherine Barrier, med-
ical social worker; Mr. James R. Abernathy,
biostatistician.

Representing the Wake County Health
Department were Dr. Isa C. Grant, health
director, and Miss Flora Wakefield, chief
supervising nurse.

•Defined as any major deviation from normal as observed by
untrained personnel.

October, 1950

PREMATURE INFANTS— GRANT AND PRESTON

447

Representing the University of North
Carolina School of Public Health were Dr.
Sidney Chipman, professor of maternal and
child health; Dr. Ellen Preston, and Dr.
James Rhyne, two pediatricians who were
students in Dr. Chipman's department; and
Dr. Bradley Wells, professor of biostatistics.

This committee met over a period of sev-
eral months. Between meetings, various
subcommittees and experts reviewed seg-
ments of the proposed plan.

The final plan worked out by this group
follows:

Selection of Sample

The original group of Wake County resi-
dents born prematurely in Wake County be-
tween October 1, 1948, and October 31,
1951, and two comparable control groups
were selected for study. The control groups
. were to consist of other Wake County resi-
dents born in the county in this same
period : those of mature birth weight and
those weighing less than 2,500 Gm (5V-2
pounds or less) at birth but not cared for
under the program. Insofar as possible the
control groups were selected in such a man-
ner that they matched the original group
with respect to the following factors re-
corded on the birth certificate listed in order
of priority: (1) single or plural birth; (2)
birth weight according to 500-Gm. intervals ;
(3) race; (4) sex; (5) place of birth; (6)
occupation of father; (7) legitimacy; (8)
age of mother; (9) total number of deliver-
ies including present birth; and (10) at-
tendant at birth.

The three groups of children totaled 423.
Group 1 (controls) were numbered 1-141;
group 2 (premature infants not aided by
the program), 142-282; group 3 (prema-
ture infants who received care under the
program), 283-423.

Method

After the sample was selected by the Sta-
tistical Section of the State Health Depart-
ment, letters were written by the Director
of Personal Health, Dr. A. H.* Elliot, to par-
ents of the 423 children involved in the
study. It was explained that their children
had been chosen for careful examination
and study within the next three or four
months. They were told that they could con-
sult their family doctor or pediatrician for
any help or explanation desired. (The Wake
County Medical Society received details of
the plan prior to its inception and voted full

approval). Parents were also told that the
public health nurse would visit them in the
next few weeks, to explain the objectives of
the study and request their cooperation. On
arrival the nurse explained what examina-
tions the children would have and obtained
consent for a review of the medical history
of the mother prior to delivery and that of
the child up to the time of the study. Most
of the parents indicated their willingness to
participate in the study.

The following studies were attempted on
each child: Review of the hospital record
of mother and baby by obstetrician or
nurse; review of the interval history ob-
tained from the public health nurse inter-
view (this included records of prenatal de-
liveries and postpartum care of the mother
obtained from private physicians and hos-
pitals, and birth data, newborn care, and
subsequent medical or hospital care of the
children) ; a complete physical examination
and medical history by two pediatricians
from the University of North Carolina
School of Public Health (including visual
acuity, ophthalmoscopic, audiometric, and
neurologic studies) ; routine laboratory
screening by a registered technician (in-
cluding hemoglobin determination, white
blood cell count and differential, sickle cell
preparation, urinalysis, test for phenylke-
tonuria, and serologic test for syphilis,
with special consultations with the Univer-
sity of North Carolina Out-Patient Depart-
ment as indicated; psychologic testing by a
competent psychologist using the revised
Stanford-Binet Intelligence scale and the
Draw-A-Man test; an evaluation by teacher
of the child's school performance as well as
his behavioral aberrations and results of
previous psychologic testing; evaluation by
an experienced social worker of the socioec-
onomic status of the family and the emo-
tional growth and development of the child.

Results

Final studies and comparisons were made
on 92 mature infants and 137 premature in-
fants. Ninety-two infants had died; 74 had
moved away, and 21 refused to have the
follow-up studies. Among the families we
were able to locate, we were fortunate to
have only 21 refusals, thanks to the excel-
lent "selling" job done by our public health
nurses.
Mortality

Table 1 shows the number of deaths. Six
of the full-term infants had died. Of the

448

NORTH CAROLINA MEDICAL JOURNAL

October, 1960

Tabic 1
Deaths Anions Premature and Control Groups by Birth Weight and Age At Death

Group 1

Group

2

Group 3

I'rem

ature

Infants

1

'rematu

re Infants

Full-term Infants

Not on Program

On P

rogram

Age at Death

Weight (Grams)

2501

Vi

eight

(Grams-

)
2501

We

ght ((

rams)

2501

Under 1001- 1501- or

Under U:

- 1501-

or

I'nder

1001-

1501- or

Total 1000 1500 2500 more

Total

1000

1500

2500

more

Tota

1000

1500

2500 more

Less than

1 day

1 — — — 1

28

4

11

10

—

1

—

—

1 —

1 day

—

12

2

6

4

—

6

5

—

1

2-6 days

11

4

7

—

—

3

1

—

2

7-27 days

— — — — —

2

—

—

2

—

2

—

—

2 —

28 days

11 mos.

5 — — — 5

7

—

—

7

—

'J

2

—

7 —

More than

1 year

2

—

1

1

—

3

—

1

2

Totals

6 — — — 6

62

10

28

24

24

8

1

15 —

premature infants who were not on the pro-
gram (group 2), 62 had died, all but 2 be-
fore reaching 1 month of age. Twenty-four
premature infants on the program (group
3) had died, all but 2 of these deaths also
occurring in the first month of life.

We are thus aware that the mortality is
very high in the first month of life. Many
of these infants did not live long enough to
be served by the program — another obvious
reason for combining the premature groups.
Table 1 also shows that in the smaller in-
fants mortality was much higher. Since we
do not have a birth weights of all the in-
fants studied, we would like to point out
that of the total number of 137 premature
infants, 33 (about 25 per cent) weighed
less than 1,500 Gm. The remainder weighed
between 1,500 and 2,500 Gm.

Physical defects

Table 2 shows the total number of defects
in the premature and mature infant groups.
Among the 229 infants studied there were
16 major defects and 28 minor defects.
(Major defects were defined as any defect
that interferred greatly with the normal
function of the individual). While the pro-
portion of children with defects was greater
in the premature group, this difference is
not statistically significant.

As you will note from this table, there
were 4 blind children among the prema-

Table 2

Types of Defects

Defects Total

Premature Full-term

Total 229

137 92

One or more major 16

1.3 3

No major;

one or more minor 28

20 8

Accessory only 92

54 38

None 93 .

50 43

tures. All of these had retrolental fibro-
plasia. Among the mental defectives in this
group, 2 were cerebral spastic. Final med-
ical histories are still to be done on some
damaged children and may affect the final
tabulation.

Table 3, showing a breakdown of major
and minor defects by weight, discloses a
concentration of major defects in children
weighing less than 1,500 Gm. at birth. This
finding is even more important since these
children comprise only about one fourth of
the premature infants studied.

Comparisons of the mean height, weight,
and head circumference of children in the
premature and full-term groups showed
that the latter held a slight advantage in
each factor. In height, the difference was
found to be approximately 2 cm. ; in weight,
from 7 to 8 pounds; and in head circum-
ference, about 1.5 to 2 cm. These differences
are significant when adjusted for the age of
the child.
Social studies

Social studies of all children in both
groups were made, using the Warner Index
standard. The I.Q. follows the usual pattern
of decreasing with social class in both
groups. Except for children in social class
III, the prematures tested at a lower level.
Persons skilled in this field will interpret
the data at a later date.

Comment

We believe that the number of cases in-
cluded in this study is not sufficient to jus-
tify drawing any definite conclusions. In
searching the literature, we could find no
comparable study extending over an equal
period of time. Some special work has been
by Dr. Margaret Dann of the New York

October, 1960 FOLLOW-UP OF PREMATURE INFANTS— GRANT AND PRESTON

449

Table 3
Analysis of Defects According to Birth Weight

Birth Weight in Grams

Defects Total

Total 229

One or more major defects |i;

Blindness

Impaired hearing

Stammering- and stuttering

Refractive errors, microcephaly

Mental deficiency, severe

Malformation circulatory system,
bone and joint

Impaired vision, clubfoot
No major, one or more minor defects

Borderline intelligence

Refractive errors

Partial blindness

Heart disease

Asthma, malnutrition

Congenital heart

Speech impediment

Malnutrition, undescended testicles

Refractive errors,

borderline intelligence

Borderline intelligence,
undescended testicle

Malnutrition, allergic disorder
Accessory only
None

4
2
1
1
6

1

1

28
4

15
1
1
1
1

1
1

1

1

92

93

Totil
Premature

137
13

4
1
1
1
5

1

20

2
11

1

1

1

1

54

50

Hospital — Cornell Medical Center, who
studied only babies weighing- less than 1,500
Gm. at birth who survived. Dr. Hilda Knob-
lock of Johns Hopkins and Dr. Cecil Drellen
of England also made studies of babies who
had quite low birth weights.

Our data need further evaluation and
analysis. We wish, however, to suggest
three possible implications of the statistics
obtained in this study.

1. Mortality among infants born prema-
turely is high. All possible measures
for reducing it should be undertaken.

2. Differences between the mature and
premature groups may change when
adjustments for factors such as age,
race, and sex of infant are made.

3. While most of the differences between
our premature and mature groups were
not significant, major defects were
found to be concentrated in the low-
weight categories.

Summary

The birth certificates of 141 full-term in-
fants were matched with those of two
groups totaling 282 premature infants.
Studies of this group showed the usual high
mortality in the neonatal period. After ex-

5C0-
1000

l
l

1001-
1500
32

9

4

1501-
2000

61
2

1

2001-
2500

43
1

and

2501
over

92
3

ID

30
20

16

20

38

43

eluding those who had died or moved away,
records of 92 full-term and 137 premature
infants were compared. Major defects were
greater in the premature group. These chil-
dren were significantly smaller in height, -
weight, and head circumference. The child
born prematurely also had a slightly lower
I.Q. as related to social class. These differ-
ences were not considered significant, but,
since they are consistently favorable to the
full-term infant, they are worthy of note.

It is too early to evaluate this study. In
our department it did stimulate interest in
the premature infant and consideration of
planned studies in the future. It is through
controlled studies such as this that health
departments can eventually help the prac-
ticing physician to make the best use of his
training and experience.

Note: This study was financed through an in-
crease in funds from the Children's Bureau of the
Department of Health, Education and Welfare,
which stipulated that a study in maternal and
child health be undertaken in North Carolina.

The authors are especially indebted to Mr. James
R. Abernathy, of the Statistical Division of the
State Board of Health, and Dr. Bradley Wells, in
the School of Public Health, who prepared the sta-
tistics and graphs cited in this paper.

450

NORTH CAROLINA MEDICAL JOURNAL

October, 1960

The Problem of Psychosis Among Felons
In the North Carolina Prison System

Martin H. Keeler, M.D.

and
Harley C. Shands, M.D.

Chapel Hill

As part of a study of the emotional
problems of inmates of North Carolina pris-
ons, a team of psychiatrists, psychologists,
and sociologists from the University of
North Carolina investigated the incidence,
course, and management of psychosis in a
sample of the 7,000 felons in the correctional
system.

The study, requested by the Prison De-
partment, was accomplished between July,
1957, and July, 1958. The term "psychosis,"
as used in the study, refers to disorganiza-
tion of the personality and loss of ability to
evaluate and test reality. Psychotic indi-
viduals are also unable to relate themselves
adequately to their work or to other people.
"Borderline," as used in this study, refers
to the presence of sufficient evidence of
psychosis to warrant immediate study in a
hospital situation.

Psychotic inmates may be transferred to
special units of the state hospital system.
At the time of the study, 50 white felons
were in the Raleigh hospital, and about 25
Negro felons in the one at Goldsboro. Dur-
ing the year 75 per cent of the 52 admis-
sions to Raleigh were re-admissions. In the
two months when hospital admissions were
most closely surveyed, 4 men were re-ad-
mitted who had been discharged within the
previous week. Although free from psycho-
sis when they left the hospital, they ex-
perienced exacerbations almost immediately
on their return to prison.

Material

The prison authorities requested the ex-
amination of a group of 31 felons consid-
ered too disturbed emotionally to fit into
prison life. These men were too unstable
for employment on the roads, and too in-
efficient and unreliable for industrial jobs

Read before the First General Session, Medical Society of
the State of North Carolina. Raleigh, May, 1960.

From the Department of Psychiatry, University of North
Carolina School of Medicine, Chapel Hill, North Carolina.

within Central Prison. If allowed to mix
with the general prison population, they
provoked violence or were otherwise vic-
timized. Many of these men were not hos-
pitalized, but were kept in prison only after
repeated trips to and from the hospital had
demonstrated that their troubles promptly
recurred in prison after hospital treatment.
The entire 31 were studied; 21 were psycho-
tic and 8 were borderline.

A sample of the 105 men who were hav-
ing the most difficulty adapting to prison
life although not considered by the author-
ities to be mentally ill, was also studied.
These men fought each other, insulted and
assaulted the guards, broke rules, and re-
peatedly attempted escape. Forty-one per
cent of a sample of these men were psychot-
ic and 35 per cent borderline, indicating
that the 105 men in the category could be
expected to include 43 psychotic and 37 bor-
derline individuals. To non-medical person-
nel their behavior was evidence of defiance ;
to physicians, their conduct, ideation, and
affect were evidence of psychosis. The Pri-
son Department suspected the existence of
the problem but lacked sufficient diagnostic
facilities to evaluate it.

From these studies 64 psychotic and 45
borderline felons could be reliably predicted
to be within the prison system. The diag-
nosis and treatment of psychosis is a med-
ical problem. These men were sick people,
in the custody of the state, who were not
receiving adequate treatment. They do not
include men who were psychotic but who
managed to "get by" in prison, nor do they
include those imprisoned for misdemeanors
rather than felonies who become psychotic.
As their psychoses may be expressed by
criminal acts after discharge, it would be
in the public interest to detect, diagnose,
and treat these men during their imprison-
ment.

There is no simple answer to the prob-
lem of psychosis in prisoners. Increased
diagnostic and hospital facilities would be

October, 1960

PSYCHOSIS IN PRISON FELONS— KEELER AND SHANDS

451

of value but would not solve the problem.
The 75 per cent rate of re-admissions to the
Raleigh unit demonstrates this fact. Ab-
stracts from prison records and hospital
charts illustrate the problem.

Case 1

Patient 0 was admitted four times and hospital-
ized for a total of 10 months in an 18-month period.

On his first admission, January 22, 1957, he
said, "I was in a room with a bunch of goats ....
Someone kept telling me to leave." There were
self-inflicted wounds on his arms and shoulders. By
the end of February he could not account for his
scars, but doubted that he had injured himself.
Late in March he was conducting himself normal-
ly, and was discharged to prison on April 1, 1957.

In prison, immediately prior to his re-admission
on October 2, 1957, he stared at the ceiling and
said, "The roof is falling down." After a few
weeks in the hospital he stated that he had thought,
in error, that everyone in prison was picking on
him and that he was "going to pieces." He was
discharged on February 2. In prison he became
detached, frantic, and slashed his arms. On Feb-
ruary 28, 1958, he was readmitted to the hospital
where he again improved rapidly. He recalled hav-
ing had hallucinations and delusions, and became
cooperative and friendly. He became depressed in
March, but recovered in April and was returned
to prison July 1, 1958. Seven days later he was
admitted for the fourth time.

Case 2

Patient P was admitted five times and hospital-
ized for 22 months in a 30-month period.

Prior to his first admission on September 15,
1955, he had been in a panic. He ran about with a
Bible in his hands, insisted on speaking with peo-
ple outside the camp, and refused to converse with
the guards or the camp physicians. He had hallu-
cinations of his mother, and was depressed and
negativistic. In October he was cooperative but
still slightly depressed. He was discharged to pris-
on on February 14, 1956, and re-admitted to the
hospital 10 days later. At this time he was re-
tarded, would not answer questions, and had audi-
tory hallucinations. In March he was still antag-
onistic, and in July he was given Thorazine, with
good effect. Improvement was considerable by Oc-
tober, and he was discharged on January 23, 1957.

He remained in prison until a third re-admission
became necessary on December 3 of that year.
Late in January he was given electroconvulsive
therapy because of hallucinations and delusions.
He improved rapidly and was discharged on Febru-
ary 22, 1958. In three days he was re-admitted, be-
ing out of contact and having self-inflicted wounds.
In March, rational but still intermittently de-
pressed, he stated that he had cut himself because

he was unhappy. By the end of May he was bet-
ter and was discharged on June 18, 1958, but was
admitted for the fifth time 23 days later.

Case 3

Patient S was admitted twice and hospitalized
all but two weeks of a 19-month period.

Prior to July 18, 1956, the date of his first ad-
mission, he was restless, noisy, untidy, uncoopera-
tive, and heard "voices" deg-rading him. He re-
ported: "The voices tell me my brother is dead. I
see eyes looking at me." Later that month, in the
hospital, he said, "The devil tells me to do bad
things ... I was in the gas chamber last night."
He received electroconvulsive and then insulin
coma therapy, and by January, 1958, was coherent
although his affect was flat. He was discharged on
January 31, 1958. On February 4, 1958, while in
prison, he said, "Everyone is talking about me ....
they're planning to kill me." He was re-admitted
to the hospital four days later.

Comment

The reversibility of psychosis may be
considered in an adaptive framework. Adap-
tation, the relation of an individual to his
environment, depends on characteristics of
both. Psychosis may be considered as either
an extremely regressive form of adaptation
or a failure of adaptation. Susceptibility to
psychosis in any situation is variable and
depends on the individual's heredity and
previous experience. The data demonstrates
that in many of these men psychosis is a
function of the environment. Even when
somatic therapy, in addition to hospitaliza-
tion, was required to produce a remission,
the improved adaptation could be maintained
in the hospital but not in the prison.

Hospital vs. prison life

Essential differences in the management
of hospitals and prisons are apparent when
the two are visited. It is the object of the
hospital to make the patient's life as pleas-
ant as possible, and to cure him if possible.
Prisons, on the other hand, go somewhat
out of their way to make the life of the in-
mate unpleasant. Two factors present in
prison but not in hospital life have been ob-
served to precipitate psychosis in other
situations. The prison produces a high de-
gree of tension in inmates by provoking
but proscribing the expression of anger;
the hospital avoids this situation. Prisoners
are also far more deprived than are patients

452

NORTH CAROLINA MEDICAL JOURNAL

October, 1960

in terms of the number and quality of
familiar stimuli and relations. Before ex-
amining these differences in detail, it is
useful to study them in historical perspec-
tive.

Less than two centuries ago mental hos-
pitals in their present forms were unknown.
Insanity was not recognized as a medical
problem. Those so afflicted were considered
as less than human or as possessed by the
devil, and were treated accordingly. Crim-
inals were not punished with prison terms.
Imprisonment might be used to coerce or
detain individuals, but punishment con-
sisted of death, torture, multilation, humil-
iation, banishment, fines, or loss of status.

There have since been far-reaching ad-
vances in the understanding and treatment
of both mental patients and prisoners. The
insane came to be recognized as sick people
and insanity as a medical problem. Asylums
became hospitals, trying to give the best
possible patient care. Later, knowledge of
psychodynamics gave deeper understanding
of the nature of mental illness and increased
the possibilities of treatment. Advances in
somatic therapy and in the knowledge of
how the hospital environment could be con-
trolled to facilitate remissions have further
transformed mental hospitals into facilities
for the care and treatment of sick people.

There have been simultaneous changes in
penology. Prison terms replaced brutal
forms of retaliation. Prisons gradually have
become more tolerable, as it became evident
that severity produces anger rather than
reform. Knowledge of individual psychody-
namics and of social forces made it plain
that the criminal was maladapted rather
than essentially evil. Emphasis shifted from
retaliation to rehabilitation. Prisoners, how-
ever, are still thought of as being bad as
well as sick; they are punished as well as
given treatment. This leads to the essential
differences between hospitals and prisons.

Prison life is tense; activities are monot-
onous and regimented; discipline is strict;
protest is not tolerated. The unreasonable
justification for this severity is the hope
that it will lead to penitence. Convicts more
commonly respond by accepting the stand-
ards and practices of the "inmate culture."
This consists of unverbalized anger and
contempt for the authorities, and the under-
cover enjoyment of illicit gratifications
such as alcohol, drugs, homosexuality, and

gambling. A few men are openly defiant
despite severe punishment. The occasional
prison riots are another form of adaptation,
as are hunger strikes and mass breaking of
limbs. Still another is expression of the an-
ger after discharge, since many convicts
can restrain their aggressive or anti-social
behavior only when directly under the eyes
of authority.

Psychotic reactions of various types oc-
cur when other adaptive efforts fail. In
paranoid phenomena, exemplified by delu-
sions of persecution, the anger is managed
by attributing it to the environment. In de-
pression, characterized by feelings of worth-
lessness and attempts at self -in jury or de-
struction, anger is directed against the self.
In schizophrenia the integrity of the self is
lost11'. The hospital environment provokes
less anger than does that of prisons, and is
more tolerant of expression. This allows
restitution at a nonpsychotic level, or at
least does not precipitate new psychotic
episodes.

Prisons and hospitals differ considerably
in terms of the number and variety of avail-
able stimuli and interpersonal relations. Vis-
iting privileges are broader and reception
arrangements more comfortable in the hos-
pital. Occupational therapy, dances, and
parties are part of life on the ward but not
of life on the cell block. Although both en-
vironments are overwhelmingly masculine,
in the hospital nurses and female patients
are frequently encountered. Inmates re-
turned from the hospital to prison are rou-
tinely kept in segregation units where facil-
ities for socializing with each other are
more limited.

There is considerable evidence that the
maintenance of psychic equilibrium depends
on the continuous supply of familiar and
gratifying stimuli. Lilly'3' has described
how sailors and explorers, isolated by
chance or intent from other human beings
develop first an extensive and vivid fantasy
life and ultimately hallucinations. He also
discovered that a much shorter period in a
dark silent immersion tank at body temper-
ature, a situation in which not only the
familiar senses but those of temperature
and proprioception are absent, may quickly
produce disorganization and hallucinations.
It has also been observed '-4| that some
aliens, who were apparently well integrated
in their homeland, develop paranoid psycho-

October, 1960

PSYCHOSIS IN PRISON FELONS— KEELER AND SHANDS

453

ses in the unfamiliar environment of their
new country, a fact attributed to the absence
of familiar stimuli, outlets, and relations.
The prison as described has many attributes
of an isolated or alien situation ; familiar
stimuli and relations are minimal. This may
affect vulnerable individuals in such a way
as to produce psychotic adaptations. In the
more varied atmosphere of the hospital res-
titution may occur.

Conclusions

The diagnosis, treatment, and prevention
of psychosis are medical problems and med-
ical responsibilities. The present manage-
ment of psychosis in prisons is not ade-
quate; the Prison Department was aware
of this fact when the present study was
requested. Increasing the capacity of the
State Hospital System to treat psychotic
prisoners would be of some help but would
not solve the problem; if more psychotics
were treated to the point of remission and
then returned to prison, re-admissions would
soon exceed the present rate of 75 per cent.
It is similarly impractical to keep convicts
who have recovered from their psychoses
in the hospital, as this would turn the hos-
pitals into prisons.

The best solution would be to increase
psychiatric facilities within the prison sys-
tem. More personnel are required. Diagno-
sis requires expert knowledge ; men that
physicians would recognize as psychotic
are seen by those not medically trained as
"strange" or "bad." Medical attention could
also help maintain remissions. Special units
in which the punitive elements of planned
frustration and deprivation are absent
should also be established to care for the
once psychotic and potentially psychotic.
Security could be maintained in these fa-
cilities, and working assignments would
not only be possible but desirable. Nothing
of importance would be lost if these men,
or even the entire prison population, were
treated in this manner.

Punitive measures in prison are of doubt-
ful value ; they cause anger rather than
penitence, and lead to forms of immediate
adaptation that have unfortunate long-
range results. They are of little deterrent
value, as individuals committing crimes
either do not expect to be apprehended or
simply do not think that far ahead. Puni-
tive measures do express the anger of so-
ciety towards the offender. This is human,
but as individuals mature they learn to
temper the impulse to "get even" if in so
doing they can better deal with a problem.

Our society is also maturing; capital pun-
ishment, where still imposed, is progress-
ively infrequent ; mutilation is long since
extinct, corporal punishment is exceedingly
rare. Working and living conditions in most
prisons, including those of North Carolina,
are much better than they were in the past.

The prison has more important functions
than punishment. Detention of criminals
gives society temporary protection from
their activities. It also provides an oppor-
tunity to initiate treatment and rehabilita-
tion. These functions are of value. There is
no evidence that additional punitive meas-
ures do any good and much to suggest that
they do harm. Relaxation of the prison at-
mosphere would not rehabilitate criminals
in itself, but it would simplify internal
management, diminish the incidence of un-
fortunate adaptative reactions, and proba-
bly facilitate rehabilitative efforts.

References

1. Fenichel, O.: The Psychoanalytic Theory of Neurosis,
New York, W. W. Norton and Company, 1945.

2. Kino, F. F. : Alien's Paranoid Reaction, J. Ment. Sc.
97:589-594 (July) 1951.

2. Lilly, J.: Mental Effects of Reduction of Ordinai-y Levels
of Physical Stimuli on Intact, Healthy Persons, Psychiatric
Research Reports of the American Psychiatric Associa-
tion, no. 5, 1956. 1, 28.

4. Prange, A. J., Jr.: An Interpretation of Cultural Isola-
tion and Alien's Paranoid Reaction, Internat. J. Social
Psychiat. 4: Spring 1959.

454

NORTH CAROLINA MEDICAL JOURNAL

October, I960

Berylliosis, Bones, and Behavior

.4/; Illustrative Case Report

■

Charles R. Rackley, M.D.

a nd

Morton D. Bogdonoff, M.D.

Durham

Berylliosis, a systemic disease developing
after exposure by inhalation to any one of
a number of beryllium salts, has been of
clinical interest, in part, because of its ex-
traordinary variability. We have recently
had a patient in whom a number of features
of this illness appeared to merit reporting.
These features included the singularity of
the exposure, the natural history of the ill-
ness, the development of renal lithiasis, and
the circumstances accompanying the onset
of symptoms after a four-year latent period
following exposure.

Case Report

Present Illness

A 36 year old white male chemical en-
gineer was first admitted to Duke Hospital
for a renal evaluation. The patient had been
in good health until he had scarlet fever at
the age of 18. He was not hospitalized at
that time, and recovered without sequelae.
At the age of 19 he was told he had albu-
minuria, but he later entered the service.
At the age of 24 he was exposed to beryl-
lium carbide for six months (January to
June, 1948) while engaged in a project to
assay beryllium for potential use in the
Atomic Energy Program.

Throughout this time and during the en-
suing four years, the patient enjoyed ex-
cellent health. Roentgenograms taken in
1948, 1950, and February. 1952, were in-
terpreted as being unremarkable (figures
1-3). In June, 1952, however, he first noted
the onset of illness characterized by easy
fatigability, dyspnea on exertion, anorexia,
weight loss, and intermittent low grade
fever. There was some nonproductive cough,
but no chest pain. These symptoms per-
sisted, and he became less able to work.
Finally, after approximately six months of
continued disability, he underwent a thor-
ough evaluation. X-ray studies revealed
progressive pulmonary changes. The follow-

From the Department of Medicine. Duke University Medical
Center, Durham. North Carolina.

Supported by Duke University Center for Study of the Ag-
in;-. U. S. Public Health Service grants M-2109 and H-3582.

ing year dyspnea and cough associated with
easy fatigability severely limited the pa-
tient's activity, and he was forced to leave
his job. Subsequently he was treated with
oral cortisone and hydrocortisone for ap-
proximately 10 months, but little sympto-
matic improvement was noted.

At about this time he first began to note
moderately severe attacks of costovertebral-
angle pain on the right side, occasionally
radiating into the flank and occasionally as-
sociated with urinary frequency. His gen-
eral health remained essentially unchanged,
although he noted some improvement in his
general work tolerance. He returned to
work in a new location and appeared to be
doing somewhat better until approximately
two years ago, when he had an episode of
acute costovertebral-angle pain and passed
a renal stone. Since then he has continued
to pass stones, and some of the episodes of
colic have been attended by fever, chills
and pyuria. The diagnosis of pyelonephritis
has been considered.

During the past year his blood pressure
has been elevated (150 100), and more re-
cently the blood urea nitrogen began to rise
(40 to 70 mg. per 100 ml.). He again
changed job locations, with continued pro-
ductivity as an engineer. In the six months
prior to admission he noted that he tired
more easily and found it increasingly diffi-
cult to concentrate. Because of these symp-
toms he was referred to Duke Hospital for
evaluation. There has been no history of
peripheral edema, hematuria, visual dis-
turbances, or headache. The family history
revealed no renal or vascular disease.

Physical examination

The temperature was 37.5 C, pulse 90,
and respiration 20. The blood pressure was
158/100 lying and 160/100 standing. The
patient was a well developed, well nourished,
sallow white male in no acute distress. Ex-
amination of the head and neck was nega-
tive. Breath sounds were prominent, with-
out rales, and the lungs were clear to
percussion. The heart was normal. Exam-

October, 1960

BERYLLIOSIS— RACKLEY AND BOGDONOFF \T~ i

455

Fig. 1. Roentgenogram of the chest made Decem-
ber, 1948, six months after exposure to beryllium
carbide.

ination of the spine disclosed no costover-
tebral tenderness. The liver and spleen
were not felt. Examination of the skeletal
and muscular systems disclosed no club-
bing. Reflexes were active.
Laboratory findings

The hemoglobin was 12.3 Gm. per 100
ml. There were 5,200 white blood cells, with
65 per cent polymorphonuclears, 3 per cent
eosinophils, 18 per cent lymphocytes, and
14 per cent monocytes. A smear showed
moderate microcytes. Urinalysis yielded the
following data : pH reaction alkaline, spe-
cific gravity 1.010, a 1 plus reaction to pro-
tein, no sugar, from 40 to 50 white blood
cells, and 5 to 8 red blood cells per high
power field. The result of a phenolsulfon-
phthalein test was 15 per cent excretion of
the dye in two hours. A urir.s culture
showed no growth. The blood urea nitrogen
was 70 mg. per 100 ml., sodium 140 mEq.
per liter, potassium 4.9 mEq. per liter,
chloride 98.3 mEq. per liter, carbon dioxide
27.2 mEq. per liter, calcium 11.7, 12.0 and
9.5 mg. per 100 ml., phosphorus 4.1, 4.2,
and 4.7 mg. per 100 ml. The total serum
protein was 7.8 Gm. per 100 ml. (albumin
4.1, globulin 3.7), cholesterol, 250 mg. per
100 ml., uric acid 13.6 mg. per 100 ml.,

Fig. 2. Roentgenogram made November, 1950,
two years after exposure. The patient was asymp-
tomatic.

magnesium 2.2 mg. per 100 ml., free cho-
lesterol 73.7 mg. per 100 ml, and lipid
phosphorus 8.34 rag. per 100 ml.

Roentgenograms of the chest (fig. 1)
showed scattered areas of calcification
among diffuse patches of parenchymal in-
filtration; abdominal films (fig. 6) disclosed
bilateral renal calculi, and x-ray studies of
the bones showed increased density with
loss of fine trabecular markings. An elec-
trocardiogram was within normal limits.
Two skin tests (OT in a 1:1000 dilution,
and histoplasmin) were both negative.

Course in the hospital

The patient was placed on the basic rice
diet and received a five-day course of strep-
tomycin and Chloromycetin. On the fifth
hospital day he spontaneously passed a
renal stone which, on analysis, was primar-
ily calcium oxalate with a relatively small
amount of calcium phosphate. The patient
had no respiratory symptoms during this
period.

Comment
Type of exposure

The most frequent type of exposure for
individuals who later manifest berylliosis
has been ir. industrial units manufacturing

45li

NORTH CAROLINA MEDICAL JOURNAL

October, 1960

ppr

Fig. 3. Roentgenogram made February, 1952,
four years after exposure and four months prior
to development of symptoms. In retrospect, the
lung fields demonstrate increased markings of a
fine, punctate quality.

items incorporating beryllium salt: radio
tubes, fluorescent lamps, alloys, and so
forth. Occasionally, beryllium salts have
been employed in the preparation of units
for nuclear radiation protection, resulting
in exposure. In the experimental setting,
however, such disease patterns are uncom-
mon.

In this instance, the patient was attempt-
ing to develop a casing for nuclear material.
Both beryllium and carbon were indicated
elements to explore, since both have the
property of modifying the speed of neu-
trons to a rate desirable to produce efficient
nuclear fission. At the time that he was
working with beryllium carbide, previous
industrial exposure to this salt had not oc-
curred and no specific hazard was consid-
ered likely. Of further interest was the in-
timate nature of the exposure. The patient
carefully weighed out units of the beryllium
carbide powder into sintering dishes, then
fired these pellets in a furnace. The sin-
tered pellets were then handled and ex-
amined closely for measures of density,
porosity, and specific gravity. Although the
total amount of beryllium actually present

Fig. 4. Roentgenogram made September, 1955,
three years after marked respiratory symptoms
had been present.

in the laboratory was probably not great,
the exposure was of such close and con-
stant range that the net effect was one of
high total dosage.

Natural history of pulmonary lesions

Little commentary in regard to the se-
quence of pulmonary involvement is neces-
sary. Figures 1-5, illustrating these lesions,
demonstrate the progressive nature of the
illness. The special features are the clear
lung fields prior to exposure, the gradual
appearance of lesions (which may be de-
tected in retrospect) just prior to the ap-
pearance of symptoms (fig. 3), and the ob-
vious and progressive character of the lung
changes once symptoms had developed. An-
other notable point is the apparent amelior-
ation of pulmonary discomfort, although
the radiographic changes have become more
marked. This feature has been recognized
previously'11.

Renal lithiasis

The literature on berylliosis indicates
that renal lithiasis developed in approxi-
mately 10 per cent of all cases. Recurrence
of hypercalcemia has also been reported.
When reviewing the reports, it became ap-
parent that, although statistical incidence

October, 1930

BERYLLIOSIS— RACKLEY AND BOGDONOFF

457

&t&

- fa*"

Fig. 5. Roentgenogram made May, 1960, demon-
strating an increase in the density of the mark-
ings with the appearance of rounded areas of cal-
cification.

was often cited, individual case reports
were rarely mentioned. The evolution of
symptoms in this patient makes berylliosis
the most likely basis for the renal lithiasis,
although a parathyroid adenoma, Boeck's
sarcoid, or idiopathic renal lithiasis may
also be considered as possible causes. A

parathyroid adenoma is difficult to estab-
lish definitively in the presence of renal
failure; histologic assessment of biopsy
material will not distinguish the granuloma
of sarcoid from a beryllium granuloma.

The basis for the lithiasis in berylliosis
is not well established. Beryllium is a mem-
ber of the alkaline-metal group to which
calcium, magnesium and strontium belong.
It has been postulated that beryllium re-
places calcium in the bone (see figure 7 for
the increased bone density characteristic of
this disorder) and that hypercalcemia and
hypercalciuria ensue. Only two cases in
which metabolic balance studies were per-
formed have been reported1-'. In these
studies, a consistent negative calcium bal-
ance (high urinary calcium and moderately
high fecal excretion) was noted. This find-
ing accompanied a consistent negative ni-
trogen balance.

It might be presumed that in our patient,
in view of the bone change and hypercal-
cemia, berylliosis had involved the bone
tissue and replaced the calcium with conse-
quent calcium mobilization, and that the
renal lithiasis developed on this basis.

Latent period and onset of symptoms

Of considerable mystery to clinicians
have been the factors determining the
length of the latent period in this disease.
The interval between the time of exposure
to beryllium salt and the onset of pulmon-
ary symptoms has varied widely — from one
month to 15 years'11. The variables deter-
mining this interval have escaped satisfac-

Fig. 6. Flat film of the abdomen demonstrating
bilateral renal calculi. Small rounded density to
the left of the transverse process of L2 is an en-
teric-coated medication.

Fig. 7. Roentgenogram of the hands, demon-
strating increased density with loss of fine tra-
becular detail.

458

NORTH CAROLINA MEDICAL JOURNAL

October, 19(30

tory analysis. It does not appear to be re-
lated to the total dose of beryllium, dura-
tion of exposure, or to age, sex, color,
familial background or general health of
the patient. There appear to be other fac-
tors influencing the balance between the
host and the inciting agent. In the patient
reported here, the possibility that behavior-
al issues were of some significance warrants
consideration. These issues may be sum-
marized as follows :

From the very first months of his mar-
riage (1949) the patient wanted to have a
family. After two years of marriage his
wife sought medical consultation because
she had not become pregnant. A series of
studies was performed, during which the
patient was quite anxious about the out-
come. Finally, two months prior to the on-
set of symptoms (April, 1952), his wife
was told that the Fallopian tubes were not
patent and that she would probably never
become pregnant. Both she and the patient
were intensely disappointed, although he
reports having tried to conceal "how upset
I was . . . she was pretty blue." The patient
experienced feelings of intense depression.
"I realized my dreams of having a family
of my own were crushed . . ."

Whether such affective experiences may
influence the balance between the patient
and the beryllium is certainly a matter for
speculation. The w o r k of Schmale<3),

Greene*41 and Engel'-"'1 indicates that these
factors may contribute to the development
of other disease entities. We would suggest
that the alterations in biology that accom-
pany meaningful affective experiences may
play a role in determining the latent period
of such a disorder as berylliosis.

Summary

A well documented clinical course of
berylliosis is presented, in which the char-
acter of exposure, the progression of symp-
toms, the recurrence of renal lithiasis, and
the circumstances under which they devel-
oped, all are sufficiently singular to war-
rant a report.

Acknowledgment

The authors wish to appreciatively acknowledge
the permission of Dr. Walter Kempner to report
this patient's history.

Reference

1. Hardy, H. L.. and Stoeckle, J. D. : Beryllium Disease. J.
Chron. Dis. 9:162-160 (Feb.) 1959.

2. Waterhouse, C, Keutmann, E. H.. Howland, S. W.. and
Bruce, R. A.: Metabolic and Cardio-Respiratory Studies
on Patients with Beryllium Granulomatosis, A. F. C.
Project Report UR-101, Health and Biology, 1950.

3. Schmale, A. H., Jr.: Relationship of Separation and De-
pression to Disease, Psychosom. Med. 20:259-277 (July-
Aug.) 1958.

4. Greene, W. A., Jr.: Psychological Factors and Reticulo-
endothelial Disease: I. Preliminary Observations on a
Group of Males with Lymphomas and Leukemias, Psy-
chosom. Med. 16:220-230 (May- June) 1954.

5. Engel, G. L.: Studies of Ulcerative Colitis: V. Psycho-
logical Aspects and their Implications for Treatment, Am.
J. Digest. Dis. 3:315-337 (April) 1958.

We must try to understand the "advantages" of the role of the phy-
sically ill person in our modern Western civilization. He is excused from
much responsibility, blame and failure. He can expect to be treated, at
least for a time, with sympathy and kindness. It is much more accept-
able to express feeling in the language of organs than it is to admit to
having feelings of dependency and regressive longings. It is much safer
to say that one has a headache than to express directly the rage felt
toward an unreasonable boss. It saves self-esteem to believe that one has
a grandular disorder rather than a deep-seated sense of sexual inade-
quacy.

By describing his difficulties in terms of the physicochemical ma-
chine, the patient throws all the responsibility on the expert "tester" or
"repairman" we call the physician or surgeon and evades responsibility
for his own health. If the difficulty is physical or structural, the patient
has only to lie still while the surgeon cuts, or to pay for the pills the in-
ternist prescribes. On the other hand, if he admits that the difficulty
exists in the interpersonal field, this obviously means that he himself
must participate in and be responsible for his recovery. This is only an-
other way of describing unrealistic dependency needs that the patient
attempts to extract from the physician. — Faucett, R.L. : Symptomatic
Management of the "Nervous" Patient, Minnesota Med. 41:692 (Oct.)
1958.

October, 1960

459

The Larynx in Health and in Disease:
A Photographic Study

J. C. Peele, M.D., M.Sc. (Medicine)
KlNSTON

The first successful movies of the larynx
were made by Dr. Francis LeJeune of New
Orleans'1'. His contributions to the subject
made him preeminent as a pioneer in this
field and stimulated interest in both direct
and indirect laryngoscopy methods. Addi-
tional contributions were soon made by
Pressman and Hinman'2', Tucker131, Lell(4),
Solo and associates'01, Lierle and Kent'61,
Herriott'7', Farnsworth'8', Jackson and
Norris'f", Clerf'lf", and Holinger'11'.

Clerf, with the technical assistance of Mr.
J. W. Robbins, devised an apparatus which
could be used in the office for photograph-
ing the larynx by mirror laryngoscopy. The
light delivered to the larynx by this appa-
ratus was of such a degree as to permit a
decrease in the size of the opening of the
diaphragm, thereby increasing the focal
depth. The results of their work were re-
ported in 1941(10). The original apparatus
was subsequently changed, and to the best
of my knowledge these changes have not
been published. All of my work in laryngeal
photography has been with the newer type
of Clerf apparatus. My first photographic
study of the larynx was presented before
the Section on Ophthalmology and Otolaryn-
gology, Medical Society of the State of
North Carolina, May 8, 1951 (12'. The pre-
sent paper represents continued efforts in
the field of laryngeal photography employ-
ing the Clerf apparatus.

The principles underlying photography
of the larynx have been well outlined by
Clerf'10'. However, the adjustment of the
apparatus and the actual process of photo-
graphing the larynx can be learned only by
experience. It is not an easy technique to
acquire, and not every larynx lends itself to
photography. For the benefit of those who
may be interested in this type of endeavor,
an attempt will be made to describe some
of the detailed technique of laryngeal pho-
tography, since I do not believe that any

Read before the Section on Ophthalmology and Otolaryn-
gology, Medical Society of the State of North Carolina, Ashe-
ville. May 5, 1959.

From the Kinston Clinic, Kinston, North Carolina.

such exposition has been previously pub-
lished.

Office Technique for Photographing
the Larynx by Mirror Laryngoscopy

The equipment used in laryngeal photo-
graphy consists of a camera, a Robo Laryn-
geal Attachment which was devised by Dr.
Louis H. Clerf and Mr. J. W. Robbins of
Philadelphia, and a No. 8 laryngeal mirror.

The camera used is a 16 mm. Bell and
Howell auto load magazine type, with a
Taylor, Hobson Cooke 2 inch F. 3.5 focus-
ing mount coated lens. A Bell and Howell
direct focuser is employed. The camera is
set at a film speed of 16 frames per second,
and the film used is 16 mm. magazine type
A Kodachrome.

The camera is fastened on to the Robo
Laryngeal Attachment by means of a screw,
as shown in fig. 1A. The lever, which is lo-
cated on the lower right side of the front
of the camera, opens the shutter of the
camera when pushed upward, and starts
the camera running when pushed down-
ward. The upper horizontal arm of a Z-
shaped metallic bar fits into the slot imme-
diately above this level (fig. IB). The lower
horizontal arm of this Z-shaped bar con-
nects with the trigger shown in figure 1C.
The trigger is situated in front of the pistol
grip.

The Robo Laryngeal Attachment is held
in the right hand by the pistol grip, with
the right index finger on the trigger. Slight
pressure backward on the trigger turns on
the lights (250-watt projector) contained
in the vertical metal housing cases (fig. ID),
while maximum pressure backward on the
trigger depresses the lever on the front of
the camera that starts the camera running
(fig. IE). The 250 watt projector bulbs
are held in place in the vertical metal hous-
ing by means of screws along the lower por-
tion of the housing.

The No. 8 laryngeal mirror has been
soldered on to a semi-rigid handle that in
turn fits into a rigid bent metal bar that
has the approximate shape of the letter Z.

460

NORTH CAROLINA MEDICAL JOURNAL

October, 1960

Fid. I

Fig. 1. Apparatus for laryngeal photography —
side view.

When assembled, this bent metal bar is
fixed in a vertical metal post by means of
a screw as shown in fig. 2A.

Adjustment of the apparatus

In order to adjust the apparatus, plug
the attached light cord into a wall socket
(110 volts). Insert the laryngeal mirror in
the vertical bar and tighten the screw to fix
it in place (fig. 2A). Remove the camera
from the apparatus, wind it up, and insert
the direct focuser, which has been adjusted
to a ground glass appearance. Now open
the camera shutter by pushing the lever on
the front of the camera upward. Open the
shutter of the direct focuser by pushing in-
ward the button on the lower left hand.
Place the camera on the apparatus. Insert
the upper horizontal arm of the Z-shaped
bar in the slot above the lever on the front
of the camera (fig. IE). Now fix the cam-
era on the apparatus by means of the screw
shown in figure 1A.

Open the aperture of the lens to the full-
est extent by means of the ring provided
for this purpose. Turn on the lights by
pulling back on the trigger, look through
the eye piece of the direct focuser, and cen-
ter the laryngeal mirror in the ground glass
of the direct focuser.

Place the apparatus on the desk or table
and put some reading material with fine
print below the laryngeal mirror at a dis-
tance which you believe represents the dis-
tance between the inferior rim of the laryn-
geal mirror and the vocal cords (fig. 2B).
Adjust the reflecting mirrors (fig. 2C) so
as to concentrate the reflected light on the
laryngeal mirror and fine print below (fig.
2B). Fix the reflecting mirrors by tighten-
ing the screws for this purpose. Once the

FIG.Z.

Fig. 2. Apparatus for laryngeal photography-
front view.

reflecting mirrors are adjusted and fixed, it
is rarely necessary to change them.

The reflecting mirrors are two in num-
ber, one on each side, and are held in posi-
tion in the vertical metal bars by means of a
screw (fig. 2D). When in position, the mir-
rors are so apposed in the midline as to form
a V with the apex forward. In the illustra-
tion only a portion of each mirror is shown
in the region of the apex of the V. The light
from the vertical metal housing (fig. ID)
is conveyed through the horizontal arm of
this housing (fig. 2E) on to the surface of
the mirror, from which it is reflected to the
laryngeal mirror (fig. 2B). In the center of
the anterior edge of each reflecting mirror
is a half-moon shaped aperture which per-
mits an unobstructed view from the eye
piece of the direct focuser to the laryngeal
mirror during the preliminary focusing.

Preliminary focusing

The object of preliminary focusing is to
try to get the lighting and focusing as near
as possible to what you think will be neces-
sary for the particular larynx to be photo-
graphed. This adjustment at best is only
approximate, but it reduces the time re-
quired for trial and error focusing on the
patient.

Look through the direct focuser and turn
on the lights by pulling on the trigger. Fo-
cus on the fine print by tilting the laryngeal
mirror toward the horizontal or vertical
plane and moving it toward or away from
the camera as necessary to secure a good
focus. The laryngeal mirror may be tilted
by simply grasping the mirror itself, but
this may break the solter. A better method
is to grasp the semi-rigid bar to which the

October, I960

LARYNGEAL PHOTOGRAPHY— PEELE

461

mirror is soldered by means of a pair of
sharp-pointed pliers, such as are commonly
used by ophthalmologists, and rotating the
bar in such a manner as to tilt the mirror
as desired.

More of the object to be photographed
(fine print or larynx) can be reflected into
the laryngeal mirror by tilting it toward
the horizontal plane and moving the mirror
further away from the camera. Too much
tilting or too great a distance between mir-
ror and camera, however, interferes with
the concentration of light on the mirror and
its reflection downward. Experiment with
the adjustment until the fine print reflected
from below into the laryngeal mirror above
is in sharp focus. The tilt of the mirror and
its distance from the camera and the fine
print as shown in figure 2B are about what
is needed for most cases of laryngeal pho-
tography. You are now ready to proceed
with photographing the larynx.

Technique For Photographing the Larynx

Anesthetize the palate pharynx by spray-
ing with a 1 or 2 per cent solution of ponto-
caine or other suitable topical anesthesia.
Have the patient pull out his tongue with a
piece of gauze held in his right hand. An
assistant stands at the left side of the pa-
tient, who is seated in a conventional
straight back chair. The assistant lowers
her right hand from above, in front of the
patient's face, and retracts the upper lip
with her right index and middle fingers
spread apart. This keeps the patient's upper
lip out of the photograhic field. With her
left hand the assistant depresses the pa-
tient's tongue with a metal tongue depressor
inserted well back over the dorsum of the
tongue to the base in order to keep it out of
photographic field.

Now take the photographic apparatus in
the right hand by means of the pistol grip,
dip the laryngeal mirror in hot water, dry
with gauze, and place against the patient's
soft palate as in routine mirror laryngo-
scopy. Look through the eye piece of the di-
rect focuser, turn on the lights, and observe
the position of the larynx in the laryngeal
mirror. Usually it is necessary to tilt the
mirror slightly or move it toward or away
from the camera in order to get all of the
laryngeal image satisfactorily reflected in-
to the mirror. Visualize the medial margin
of the vocal cords and focus until the mar-
gins are in sharp focus. Look along the left

side of the camera and note the position of
the apparatus in relation to reflected image
of the larynx. Remove the mirror from the
patient's throat while the assistant re-
leases the upper lip and removes the tongue
depressor.

Remove the camera from the apparatus,
take out the direct focuser, insert the film,
and close the camera. Since this closes the
shutter of the camera, be certain to open it
again. Close the lens aperture to the de-
sired F-stop (F-stop 8 is usually satisfac-
tory for photographing all larynxes that
can be photographed). Replace the camera
on the apparatus as before. The assistant
resumes her former position. Heat the
laryngeal mirror by dipping it in hot water,
dry, and place against the patient's soft
palate as before, being certain that the ap-
paratus is placed in as nearly the same posi-
tion as during the previous focusing. This
is done only by sighting along the left side
of the camera. Turn on lights and check the
lighting and position of the larynx in the
mirror. If satisfactory, start camera run-
ning and make 20 feet or more ot film.

Difficulties and precautions

The higher the larynx is situated in the
neck, the more accessible it is for photo-
graphing. A deep-seated larynx cannot be
photographed. A large, thick tongue makes
the procedure impossible, and excessive
salivation or constant swallowing may hin-
der it. The gag reflex can usually be con-
trolled by adequate anesthetization. When
the soft palate is unusually relaxed it tends
to fold around the side of the mirror and
obscure the image of the larynx along this
side. If the preliminary focusing has not
been very accurate, considerable time is
needed to focus on the vocal cords. Because
the photographic equipment is heavy, the
procedure may be tiring and require rest
periods if the preliminary focusing has not
been accurate.

When the procedure for photographing
the larynx is started, be certain that the
camera is wound up, the shutter open, the
lens aperture closed to the proper F-stop,
and that the laryngeal mirror is placed in
the proper position against the palate. It is
impossible to visualize the larynx except by
looking along the left side of the camera
once the film has been inserted. Do not keep
the lights burning so long as to cause them
to become overheated and burst.

462

NORTH CAROLINA MEDICAL JOURNAL

October, 1960

*

Fig. 3. Normal larrynxes: (a) Quail (upper left), (b) Rabbit (upper right), (c) Dog (lower left), (d)
Human (lower right).

Fig. 4. Pathologic conditions of the larynx: (a) Carcinoma of the epiglottis (upper left). Inflammatory
polyp (upper right), (c) Papilloma (lower left). Tuberculosis of the epiglottis (lower right).

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LARYNGEAL PHOTOGRAPHY— PEELE

463

Fig;- 5. Pathologic conditions of the larynx (continued), (a) Traumatic hematoma of the epiglottis (left),
(b) Paralysis of the vocal cord (right).

Discussion of Illustrations

A study of figure 3 will afford the reader
some idea as to the relative complexity of
the anatomy of the larynx of the quail, rab-
bit, dog, and human being. The larynxes of
the quail, rabbit, and dog are dissected
specimens which were mounted and photo-
graphed in the fresh state. The human
larynx was photographed in the living pa-
tient. The larynx of the quail (upper left)
is somewhat typical of that of domestic
fowls. It is represented by a longitudinal
slit in the floor of the mouth, which serves
as an airway but is not concerned with pro-
duction of sound. Sound in fowls is pro-
duced by the syrinx (lower-larynx) and
air-sacs attached to the tracheobronchial
tree. The larynx of the rabbit is seen in the
upper right of the figure and that of the
dog in the lower left, while the human
larynx occupies the lower right hand por-
tion of the figure. The vocal cords of the
human larynx are in a position of abduc-
tion, as is seen in quiet respiration.

Figures 4 and 5 represent some pathologic
conditions of the larynx.

Figure 4 (upper left) shows an extensive
carcinoma of the epiglottis. Figure 4 (up-
per right) shows a large inflammatory
polyp completely filling the laryngeal in-
troitus. In the lower left of the figure is a
mulberry-appearing papilloma occupying the
space between the vocal cords. In the lower
right of the illustration is a swollen epi-
glottis due to tuberculosis.

Figure 5 (left) show a traumatic hema-
toma of the epiglottis, and (right) paraly-
sis of the vocal cord (reader's right). Note
that the vocal cord is abducted and appears
shorter than the opposite cord because of

the forward tilt of the arytenoid cartilage
on the paralyzed side.

Report of Cases

Case 1

A 60 year old white man gave a history of sore-
ness on the right side of his throat on swallowing',
of about one year's duration. Four months pre-
viously a "knot" developed in the left side of his
neck following a severe sore throat associated with
marked systemic symptoms. The "knot" had con-
tinued to enlarge rapidly.

Mirror laryngoscopy in the office revealed an ex-
tensive ulcerative lesion of the epiglottis (fig. 4,
upper left).

Direct laryngoscopy and biopsy were done. The
pathologic diagnosis was cornyfying squamous cell
carcinoma, grade 2.

Case 2

A 16 year old Negro girl had been subject to
gradually progressive hoarseness following a se-
vere sore throat two months before. There were
no other symptoms referable to the larynx.

Mirror laryngoscopy in the office revealed a large
pinkish-white smooth growth in the region of the
anterior commissure and adjacent vocal cords.
When the patient phonated, the mass projected
above the vocal cords and completely filled the in-
troitus of the larynx, as shown in figure 4, upper
right.

Direct laryngoscopy and biopsy were clone. Com-
plete removal of the growth required two addition-
al procedures. In each instance the pathologic diag-
nosis was inflammatory polyp.

Case 3

A white woman, 62 years of age, had become
hoarse 36 years before. She consulted a well known
otolaryngologist at the time and was told that she
had a growth in her throat which should be re-
moved. She did not accept this advice, but con-
sulted a chiropracter who gave 60 light treatments
to the neck without effect on the hoarseness. She
then saw another otolaryngologist who removed
her tonsils. This measure also had no effect on the

464

NORTH CAROLINA MEDICAL JOURNAL

October, 1900

hoarseness, which had persisted constantly since
the onset until the patient came under my obser-
vation.

About 1944 she began to experience considerable
difficulty in talking-. The voice became muffled,
"broke" cften, and became so low-pitched as to be
hardly audible. At times she was aphonic. Two
months befor? she came under my observation she
began to expedience difficulty in breathing. She
consulted her family physician, who suspected a
cardiovascular condition and prescribed according-
ly. When the patient failed to respond, obstruction
to the airway was suspected, and she was referred
to me for diagnosis and treatment.

Mirror laryngoscopy in the office revealed a
large, reddish, mulberry-appearing mass arising
from the subglottic larynx beneath the anterior
commissure. On phonation the growth projected up-
ward between the vocal cords as shown in figure
4, lower left. At times it completely filled the laryn-
geal introitus.

Direct laryngoscopy was done for biopsy, and
the remainder of the growth was removed at a
second procedure. In both instances the pathologic
diagnosis was squamous papilloma.

Case U

A white man, 45 years of age, complained of
hoarseness, difficult and painful swallowing, cough,
and general symptoms. He had previously been
treated in a sanatorium for pulmonary tuberculo-
sis, but had failed to follow his prescribed medical
regimen after discharge. The presenting symptoms
had been present for about six months.

Mirror laryngoscopy in the office revealed a
pale-red swollen epiglottis (fig. 4, lower right)
and extensive ulceration of both vocal cords and
the interarytenoid space (not shown in the illustra-
tion).

Biopsy was not done, since the diagnosis of pul-
monary tuberculosis was established by a positive
sputum examination and chest roentgenogram.

Case 5

A 62 year old white woman had been eating the
tip of a chicken wing a short while before she
came under observation. Without any symptoms to
suggest that she had swallowed or aspirated a
foreign body, the patient suddenly became frantic
at the thought that she might have done so. She
immediately began to remove the imagined foreign
body by vigorously manipulating the pharynx.
This induced gagging, vomiting, and coughing.
The patient's sole complaint was the sensation of
a foreign body in the throat.

Mirror laryngoscopy in the office revealed a he-
matoma of the epiglottis, as shown on the left
side of figure 5.

Case 6

A 37 year old Negro woman gave a history of
gradually developing hoarseness for the past six
months. She cerebrated slowly. Contact with her

friends and relatives established the fact that she
had been in good health until the fall of 1952,
when she began to complain of headaches and
dizzy spells, and personality changes became no-
ticeable.

Mirror laryngoscopy in the office revealed paraly-
sis of the vocal cord (fig. 5, to reader's right).
Suboccipital craniectomy and upper cervical lam-
inectomy performed by a neurosurgeon established
the diagnosis of a syringomyelic cavity extending
from the upper cervical region into the lower me-
dulla. The paralysis of the vocal cord was of cen-
tral origin, due to syringomyelia.

Summary a)id Conclusions

The apparatus and technique for photo-
graphing the larynx have been described.
The normal larynx of the quail, rabbit, dog,
and human being have been included in the
illustrations for comparison, and pathologic
conditions of the larynx have been described
in the case reports and illustrations.

Laryngeal photography is unexcelled as a
medium for studying the normal function
of the larynx, for recording pathologic con-
ditions of the larynx, and as a medium for
teaching.

References

1. (a) LeJeune, F. E.: Suspension Cinematography of the
Larynx. Arch. Otolaryng. 18:70-77 (July! 1933. (b) Le-
Jeune, F. E. : Motion Picture Study of Laryngeal Le-
sions. Sure. Gynec. & Obst. 62:492-495 (Feb. 15) 193G.

2. (a) Pressman. J. J., and Hinman. A.: A Simple Tech-
nique for Taking Motion Pictures of the Larynx in Ac-
tion. Arch. Otolaryne. 26:526-530 (Nov.) 1937. (b) Press-
man. J. J., and Hinman. A.: Further Advances in the
Technique of Laryngeal Photography. Laryngoscope 50:535-
546 (June) 1940. (c) Pressman, J. J.: Sphincter Action
of the Larynx. Arch. Otolaryne. 33:351-377 (March)
1941.

3. Tucker. G. A.: Technique For Motion Picture Photo-
graphy of the Larynx in Color, Tr. Am. Laryng. A.
61:259-263, 1939.

4. Lell. W. A.: Motion Pictures of the Human Larynx,
Arch. Otolaryng. 30:344-351 (Sept.) 1939.

5. Solo. A., Fineberg, N. L.. and Leverne, G.: Simplified
Apparatus for Laryngeal Cinematography. Arch. Oto-
laryng. 30:437-439 (Sept.) 1939.

6. Lierle, D. M., and Kent. F. W.: Colored Photography of
Diseases of the Larynx. Tr. Am. Laryng. A. 62:211-212
(May) 1940.

7. Herriott, W.: High-Speed Motion-Picture Photography.
Bell Lab. Rec. 16:279-281 (April) 1938.

8. Farnsworth. D. W. : High-Speed Motion Pictures of the
Human Vocal Cords. Bell Lab. Rec. 18:203-208 (March)
1940.

9. Jackson, C L.. and Norris. C: Cinematographic Study
of the Larynx after Laryngofissure. Presented at the
Meeting of the American Academy of Ophthalmology and
Otolaryngology, 1941.

10. Clerf. L. H.: Photographic Study of the Larynx by Mir-
ror Laryngoscopy, Arch. Otolaryng. 33:378-383 (March)
1941.

11. Holinger, P. H., in Jackson, C. and Jackson, C. L.: Dis-
eases of the Nose, Throat, and Ear, Philadelphia, W. B.
Saunders Co.. 1945.

12. Peele. J. C: Diseases of the Larynx: A Photographic
Study, North Carolina M. J. 13:143-147 (March) 1952.

October, 1960

465

Chronic Disease Program
In the Charlotte-Mecklenburg Health Department

elizabeth conard corkey, m.d.
Charlotte

All health departments engage in activi-
ties having to do with chronic disease. It
is only as such activities are integrated
into a well planned whole, however, that
we can say that we have a chronic disease
program.

A good program should include good pre-
planning. Some method of estimating the
need and a plan for case finding are neces-
sary. There must be resources for diagnosis
and treatment of discovered cases or the
program is a futile gesture. Finally, there
must be a means of keeping and summar-
izing adequate records so that the effort
expended can be evaluated at intervals.
Such well planned, well executed, and well
evaluated programs are rare. Constant de-
mands for service cause us to ride off in
all directions, so that we often feel that
our activities are "full of sound and fury,
signifying nothing."

How do we develop a program from the
many activities crying for attention? Some-
times programs grow spontaneously. Com-
munities demand certain activities, and we
later construct the supporting framework.
On other occasions a program springs, like
Athena, full grown from the head of Jove.
In Charlotte, we find ourselves with many
chronic disease activities in various stages
of development.

For the sake of clarity, let us accept the
definition of chronic disease used by the
Commission on Chronic Illness'11: "Chronic
Disease comprises all impairments or de-
viations from normal which have one or
more of the following characteristics:

Are permanent

Leave residual disability

Are caused by nonreversible pathologic

alterations

Require special training of the patient

for rehabilitation

May be expected to require a long period

of supervision, observation or care."
Let us further agree that chronic disease
programs can be directed toward primary
prevention — for example, averting the ini-

tial occurrence; and secondary prevention
— for example, early discovery, halting the
progress of the disease, and preventing
serious sequelae.

As public health personnel, we have had
experience in both areas of prevention.
Let us mention two examples. In maternal
and child health programs we have stressed
primary prevention of disease by promo-
tion of health and immunization against
specific diseases. In tuberculosis programs
we have stressed secondary prevention by
early diagnosis and intensive treatment to
limit the irreversible pathologic changes.

We have also learned that we do not
have to be personally responsible for carry-
ing out every step of a program. To cite the
maternal and child health program again,
we are gratified when private physicians
carry out the bulk of well-child supervision
and immunization practices in their own
offices. We feel the necessity, however, of
carrying on where their activities leave off,
notably among the careless, the ignorant,
and the indigent. But where other agencies
will assume responsibility for any part of
a program, we are ready to assist or to re-
tire.

For this discussion I want to describe
briefly some current chronic disease pro-
grams and activities in Charlotte.

Bedside Nursing

In February, 1919, the Charlotte Coop-
erative Nursing Association was organized.
Direct financial support came from the
Woman's Club, the Good Fellows Club, the
Red Cross, and four textile mills. Visits
were sold at cost to the Metropolitan Life
Insurance Company and Western Union,
and to patients able to pay. Approximately
one third of the total budget came from
city taxes.

The nursing unit was under the direc-
tion of the health officer and director of
nursing. Although later the textile mills
and the Metropolitan Life Insurance Com-
pany withdrew their support, the Woman's
Club and the Good Fellows Club continued

466

NORTH CAROLINA .MEDICAL JOURNAL

October. 1960

to give financial assistance for the bedside
program until 1935, when the City of Char-
lotte assumed all financial responsibility.
At present no charge is made to anyone
for the service.

The population of Charlotte has steadily
increased. At present it is estimated at
165,000* Thirty-six nurses are participat-
ing in a generalized program, including
bedside nursing, under the direction of a
director of nurses and two supervisors. Pa-
tients may be referred to the nursing serv-
ice by social agencies, clinics and physi-
cians, and individuals. A visit is made in
response to every call, regardless of finan-
cial status, and services are given patients
on the basis of need. No treatment or med-
ication is ever given by the nurse without
an order from a physician. When cases are
referred by social agencies or individuals,
the nurse counsels with the patient to see
that he is placed under the care of a pri-
vate physician or a clinic according to his
financial status. She is then in a position
to give the needed service.

The following table indicates some types
of patients visited.

Table 1

Public Health Nurses
Patients With Chronic Diseases Visited Bv
1958-1959

Disease No. Cases No. Visits

Heart 620 7732

Cancer 103 967

Diabetes 187 2181

Arthritis 92 817

It is obvious that these visits represent
a considerable expenditure of time and
money for the alleviation of the effects of
chronic disease.

Diabetes Program
In contrast to the Bedside Nursing Pro-
gram (or, more correctly, "bedside nursing
activities"), which grew slowly, is the Dia-
betic Program. The United States Public
Health Service survey in Oxford, Massa-
chusetts, indicated that 1.7 per cent of the
population is diabetic (according to Dean
W. C. Davison at Duke, the incidence
among children is 1 in 2,500). It is well
known that the likelihood of diabetes in-
creases with age. The incidence in our
community was not known, but it seemed
likely that similar rates prevailed. Fur-
thermore, it was not unlikely that the num-

*The 19G0 Census places it at more than 200,000.

ber of unknown cases would approach that
of the known.

Blood for diabetes screening and other
tests is drawn from all applicants for admis-
sion to the prenatal clinic at Good Samaritan
Hospital, all patients admitted to the in-
digent medical clinic, the venereal disease
clinic, and all other persons requesting
blood tests who are 21 years of age or
older (for example, applicants for pre-
marital blood tests) .

Laboratory slips are prepared in dupli-
cate and sent with two specimens, one for
a serologic test for syphilis and one for
blood-sugar screening, to the laboratory of
the Health Department. The data recorded
on the slips at the time blood is drawn are :
date, laboratory test, name, address, color,
age, sex, past history of diabetes, and the
name of the clinic requesting a laboratory
examination.

Blood sugar is tested at 160 mg. per 100
ml. on the clinitron, and the results are
recorded on the laboratory slip. All speci-
mens testing positive at this level are re-
tested by the Folin Wu method and the re-
sults of both tests are recorded in a ledger.

Patients with positive results at 160 mg.
per 100 ml. on the clinitron but below 150
mg. per 100 ml. by the Folin-Wu method
have not been recalled. All those testing
between 150 and 200 mg. per 100 ml. by the
Folin-Wu method are recalled and tested,
after a test meal, at one and two hour in-
tervals, both for blood sugar and urine
sugar. Those testing higher than 200 mg.
per 100 ml. by the Folin Wu method on the
original specimen are recalled for fasting
blood sugar determinations and modified
glucose tolerance tests later, if indicated.

It has been found preferable to have a
public health nurse visit all persons re-
called for retesting. A visit gives the nurse
an opportunity to interpret to the patient
the meaning of the positive screening test
and the importance of diagnostic studies,
as well as to instruct the patient about
what to eat before the retest. If the nurse
fails to see the patient, a follow-up letter
is sent. Retesting is offered to all with pos-
itive reactions, without financial eligibility
screening.

When patients return for retesting, they
are interviewed by the clinic nurse and a
history is taken. The history includes: (1)

October, 1960

CHRONIC DISEASE PROGRAM— CORKEY

467

previous diagnosis of diabetes, (2) family
history of diabetes, (3) symptoms, (4)
complications or other diseases and signifi-
cant conditions.

Patients coming from the prenatal and
general medical clinics have already been
screened for financial and residence eligi-
bility. Other screenees from the venereal
disease clinic and applicants for health
cards are asked by the clinic nurse where
they will receive their medical services. If
they do not have a private physician and
are probably eligible for clinic service, an
application is prepared for social service
screening.

If the results of the test are positive, pa-
tients eligible for clinic services are ad-
mitted to the general medical clinic for
further testing, if indicated, and diagnosis.
Then the patient is followed by, and con-
tinues to receive medical supervision from,
the clinic. Patients who are not eligible for
clinic services are directed to their private
physicians with a request to return a re-
port of the diagnosis. Those patients who
are referred to private physicians are fol-
lowed by the public health nurses until they
are known to be under medical care. Nurs-
ing follow-up may continue if the patient
and the physician so desire.

A register card suggested by the records
consultant has been prepared and is in use.
A monthly tabulation of screenees by clinic
source, age, sex, and race is also in active
use.

This program and method of recording
conform strictly with procedures estab-
lished by the USPHS. The Service paid the
salary of a nurse, lent a clinitron, and
furnished other equipment and reagents.
It also provided expert consultation on
records.

Over and above the bare statistics, unex-
pected dividends have accrued to the de-
partment. There was a new interest and
concern with diabetes as a public health
problem. A workshop on diabetes was held,
to which public health nurses from neigh-
boring counties were invited. Nurses took
a more intelligent interest in their diabetic
patients and were able to render more valu-
able service. The medical clinic for in-
digent patients had long been seeing dia-
betic patients. Now these patients became
of special interest to the nurse in charge
of the program. She familiarized herself

with their problems and interpreted their
needs to the doctor. With this data, he
was able to give them better professional
care.

At present the clinic is following 52
cases* of diabetes, including 16 newly dis-
covered cases and 5 old ones rediscovered by
the program. The nutritionist holds in-
dividual conferences on diet with patients.
Her advice is then made available to nurses
carrying the patients in their case load.
Efforts are also being made to test fam-
ilies of diabetic patients. It is hoped that
space in the new building will be found for
a more extensive educational program for
patients.

Heart Disease Program
A heart disease program has been needed
for some time. As in other communities,
heart disease is our leading cause of death.
Table 1 shows that during the past four
years 27.6 per cent of the morbidity visits
have been made to patients with cardio-
vascular disease. Activities having to do
with cardiovascular disease previously in-
cluded education, home nursing, and pa-
tient visits to the indigent medical clinic.
These activities were not organized, and
neither primary nor secondary prevention
were seriously considered.

A very small beginning of a program
was made in June, 1956, with the establish-
ment of the Children's Heart Clinic, held
once a month. This clinic was originally
established with the cooperation of Heart
Services and the Charlotte-Mecklenburg
Public Health Department. In December,
1956, the Crippled Children's Division of
the State Board of Health authorized the
establishment of a Rheumatic Fever Con-
trol Center. In June, 1957, two clinics a
month came into being. Any child may be
referred to the clinic by a physician, irre-
spective of financial status. After the ini-
tial evaluation, or if the child is accepted
for service, welfare certification under the
Crippled Children's program is required.

The financing of the clinic is compli-
cated. Two clinicians serve each clinic, and
are paid by the Crippled Children's Divi-
sion of the State Board of Health. We are
also reimbursed on the basis of the number
of patients attending a clinic. In addition
to these funds, Heart Services contributes
toward the services of a part-time senior

*In July 1960, So cases were being carried.

4(58

NORTH CAROLINA MEDICAL JOURNAL

October, I960

public health nurse who is in charge of the
program.

Heart Services also provides considerable
equipment for the clinic and volunteers to
help in the transportation of children, to
serve as clinic aides, and occasionally to
give special medication. Oral and intramus-
cular Bicillin are provided by the Crippled
Children's program for eligible children.
When children are ineligible because of
age, the City-County Health Department
provides drugs for those unable to pay.

A records consultant from the USPHS
gave assistance in this department, and
this year a cardiac register was established.

This program has elements of primary
prevention. The child who has had rheu-
matic fever without demonstrable heart
disease gets prophylactic medication. The
majority of patients, however, already
have either congenital or rheumatic heart
disease. Prophylaxis is also required for
secondary prevention — for example, halting
the disease process and preventing such se-
quelae as myocarditis and cardiac decom-
pensation. Even this has not been com-
pletely possible. So far, we have lost one
patient with rheumatic heart disease. It
has become obvious that many of these
children should be followed into adulthood.
We hope that this can be arranged.

An important element in secondary pre-
vention is case finding. Routine school ex-
aminations have brought some cases to
light. The Mecklenburg Heart Association
has taken an active interest in the problem
by organizing heart surveys in various
schools. The local committee sends out his-
tory cards to all parents and makes sure
that all are returned. Public health nurses
take pulse rates and blood pressure read-
ings on all children. On the appointed day,
a team of volunteer physicians examines
the hearts of the children by auscultation —
a time-consuming activity. Many murmurs
are detected, but the number of cases of
significant heart disease is small. It will
take years of follow-up to see how many
of these children with murmurs, but no
history of rheumatic fever and no other
sign or symptom of heart disease, develop
significant cardiac changes. The differential
diagnosis between functional and patholog-
ic murmurs is not easy, even for skilled
clinicians. I am reminded of the old say-
ing: "The only doctor who never makes a

mistake is the one who never holds a con-
sultation or does an autopsy."

Glaucoma Screening

Among the many disabling conditions,
blindness is one that imposes severe limi-
tations on the patient. Public health pro-
grams have long stressed the primary pre-
vention of blindness. Examples are the use
of silver nitrate in the eves immediately
after birth to prevent ophthalmia neona-
torum, and the compulsory prenatal blood
test for the diagnosis of syphilis, a leadin.tr
cause of keratitis and optic atrophy. In
other countries the emphasis on vitamin A
in the diet has prevented keratomalacia.
Trachoma has also been
abroad and in this country
dians. At present glaucoma
a leading cause of blindnes
try.
the

attacked both

amon<r the In-

is classified as

: in this coun-

In California it causes 14 per cent of

cases of adult blindness. Case-finding

programs have been carried out in various
cities. It has been estimated that from 2.5
to 3 per cent of persons over 40 will have
elevated tonometer readings, and 2 per cent
will prove to be glaucomatous.

In 1957 a group of ophthalmologists,
scheduled a week's screening program in
Mercy Hospital. This program proved
so fruitful that it was repeated in 1958.
This time the planning was more extensive.
Volunteers acted as hostesses, two public
health nurses were assigned to assist the
doctors, and representatives of the Na-
tional Association for the Prevention of
Blindness participated. Of 750 patients
tested, 42 had ocular hypertension. These
patients were advised to see their physi-
cians, but there was no organized follow-
up. This year the screening week will be
even more carefully organized. Public
health nurses will again assist, and the
capable president of the state chapter of
the National Association for the Preven-
tion of Blindness is in charge of the
volunteers. Follow-up letters will be sent
by the organization to all patients with
positive readings and to their doctors.
Where no reply is received, public nurses
will cooperate in follow-up.

Comment

The long established tuberculosis and

venereal disease programs are really

chronic disease programs and serve as good

prototypes in planning attacks on hither-

October, 1960

CHRONIC DISEASE PROGRAM— CORKEY

4C'.i

to unexplored areas of chronic disease. Tu-
berculosis programs, especially, have pio-
neered in the field of discovery through
screening, and control through long-term
follow-up aided by the use of a case regis-
ter.

With the advent of new drugs, tubercu-
losis and venereal disease show promise of
being cured. In diabetes, rheumatic heart
disease, and glaucoma we have three
chronic diseases which at present we can-
not hope to cure. Only continuous medical
supervision and treatment offer any hope
for prevention of disability or death. This
requires a great deal of understanding, dis-
cipline, and cooperation on the part of the
patient. In low income groups it may re-
quire great personal and family sacrifice
as well. This is so clearly evident that one
wonders why we do not devote more at-
tention to the economic impact of chronic
disease. Families on marginal incomes can-
not add even $5.00 a month to the budget
without real deterioration in an already de-
pressed standard of living. Insulin or pen-
icillin, together with private medical care,
can rarely be purchased for so little. It is
a paradox that while a categorical grant
can be given to the disabled, few commun-
ities have any way to care for the low in-
come diabetic or rheumatic heart patient
before he becomes disabled.

We do not yet know how to get primary
prevention for many diseases. We do un-
derstand secondary prevention, but often
it is not provided. It has been a personal

satisfaction to me to feel that, after new
cases are found by means of screening pro-
cedures, we have clinic facilities to carry
through a program of secondary preven-
tion. I am also convinced that, as with tu-
berculosis, the best case yields come from
people seeking medical care in clinics or
doctors' offices. Every practitioner should
be on the alert for diabetes and glaucoma
in patients over 40. Yet recently an inter-
nist told me he discovered diabetes in a pa-
tient finally referred to him for diagnosis
after 12 years of care by his physician!

Summary

Chronic disease programs in home nurs-
ing, diabetes, and children's heart disease
have been described. Activities aimed at
the discovery of glaucoma have been re-
viewed. On the basis of our experience it
is probable that there are at least 1,600 un-
discovered cases of diabetes in Charlotte
and Mecklenburg County. There may well
be twice that many cases of glaucoma.

As more children are born each year,
cases of congenital heart disease and rheu-
matic heart disease can be expected to
swell our case register by at least 100 a
year. A means of following children with
rheumatic heart disease into adulthood is
necessary to complete the picture.

It is obvious that there is a great need
for the development of chronic disease pro-
grams designed to discover new cases and
to see that these patients receive the pro-
per care and follow-up. A case register is
a useful tool in every program.

Hepatic Amebiasis Treated with Plaquenil

Case Report

Hugh O. Queen, M.D.
Hamlet

Intestinal amebiasis is often complicated
by involvement of the liver which may be
slight, causing only focal necrosis, or ex-
tensive, forming multiple small abscesses
or a single large abscess. The disorder
should be treated as soon as it is suspected
to prevent widespread hepatic damage,
which may prove fatal. None of the pre-
sently available amebicidal agents will cure
both intestinal and extra-intestinal amebi-
asis, and a combination of two or more
drugs is advisable. Chloroquine phosphate

(Aralen)*, a relatively nontoxic, oral ame-
bicide, has been recommended as an effect-
ive agent against liver infections since its
first use in 1948 (1). More recently another
4-aminoquinoline, hydroxychloroquine sul-
fate (Plaquenil)*, has been found as ef-
fective as chloroquine in treating hepatic
amebiasis, although it has had limited use
up to now'2'. Plaquenil may offer an impor-

*Aralen Phosphate, brand of chloroquine phosphate; Plaque-
nil Sulfate, brand of hydroxychloroquine sulfate, Winthrop
Laboratories, New York, New York.

470

NORTH CAROLINA MEDICAL JOURNAL

October. 1960

tant advantage over chloroquine, since it
appears to be better tolerated.

In the following case report, a history
suggestive of acute amebic hepatitis was
confirmed by the presence of Endamoeba
histolytica in the stools. Encouraged by
Sepulveda's most recent report111'" led to the
use of Plaquenil in an attempt to cure the
hepatic infection. The intestinal focus was
treated with tetracycline.

Case Report

A 10 year old white male was first seen
on May 13, 1959. He complained of abdom-
inal pain, headache, and anorexia of three
months' duration which had become worse
in the week before examination and caused
absence from school for three days. Abdom-
inal pain was generalized, but was most
painful in the right upper quadrant. The
boy had lived in five different parts of the
country while his father was in military
service.

Physical examination showed a pale,
sallow boy with approximately 50 small
hemangiomas over the upper trunk, face,
neck, and edge of the scalp. The most re-
markable feature was tenderness in re-
sponse to light pressure over the liver and
right upper quadrant and some slight gen-
eralized abdominal tenderness. There was
no jaundice, diarrhea or vomiting.

Laboratory data: The hemoglobin was
9.8 Gm. per 100 ml. The icterus index was
5 units. The direct Van den Bergh test was
negative after 10 and 30 minutes, the in-
direct Van den Bergh was 0.15 mg. per 100
ml, after 10 and after 30 minutes. Stools
were positive for cysts of Endamoeba his-
tolytica.

Achromycin (tetracycline) oral suspen-
sion (125 mg. per 5 cc.) was prescribed in
doses of 1 teaspoonful four times daily for
the intestinal infection. Fergon Compound
Liquid* (ferrous gluconate, 250 mg. per 5
cc, with vitamin B complex) was given in
doses of 1 teaspoonful three times daily to
correct the slight anemia.

The patient was seen again on June 6.
There had been a great improvement in ap-
petite and no further abdominal pain ex-
cept mild soreness in the right upper quad-
rant. The patient felt the medicine had been
very helpful. Physical examination showed
only one small angioma. Facial color was
better. Although there was no generalized

abdominal pain, a mild thump over the liver
produced moderate discomfort. The hemo-
globin had risen to 11.5 Gm. per 100 ml.

Plaquenil was given in doses of one 200
mg. tablet, twice daily for two days and
then once daily for 14 days.

On June 16 there was less tenderness
over the liver area and the patient felt
much better. At the final examination on
June 25 there were no complaints and phy-
sical signs were normal. Stools were nega-
tive for E. histolytica on June 10, 16, 18
and 25.

Summary

A 10 year old patient with hepatic ame-
biasis was successfully treated with Pla-
quenil sulfate. This case is of particular in-
terest since there have been few published
reports of Plaquenil as an amebicidal agent.
It is well tolerated, and further exploration
of its value in extra-intestinal amebiasis is
warranted.

References

1. la) Conan, N. J.: Chloroquine in Amebiasis, Am J.
Trop. Med. 28:107-110 (Jan.) 1948. (b) Shookhoff. H. B.:
Protozoan Infections, in Cecil, R. L., and I.oeb, R. F.: A
Textbook of Medicine, ed. 9, Philadelphia, W, B. Saunders
Co.. 1955, pp. 393-397. (c) Kean, B. H., and Chowdhury,
A.B.: The Choice of Drugs for Intestinal Parasitism, in
Modell, W.: Drugs of Choice 1968-1959. St. Louis, C. V.
Mosby Co.. 1958, pp. 412-423.

2. (a) Sepulveda. B.: Advances recientes en el tratamiento
de la amibiasis hepatica, Gac. med. Mexico 87:415-416
(June) 1957. (b) Sepulveda. B.. Jinich. H.. BassoK F..
and Munoz, R. : Amebiasis of the Liver; Diagnosis, Prog-
nosis, and Treatment, Am. J. Digest. Dis. 4:43-64 (Jan.)
1959. (c) Haro Y Paz, G.: Amebic Dysentery in Mexico,
Am. J. Gastroenterol. 32:71-75 (July) 1959.

*Fergon Compound Liquid,
York, New York.

Winthrop Laboratories, New

REPORT FROM

The Duke University
Poison Control Center

J. M. ARENA, M.D., Director

A 3 year old white boy was admitted to
the Duke Pediatric Service in 1958 with
the chief complaint of convulsions clue to
a fall in which he struck his head. The his-
tory of the complaint and the symptoms
did not coincide, and our staff, being always
conscious of intoxication, began further
questioning along these lines. The following
history was obtained.

The child had been well until the day be-
fore admission, when lethargy and pain de-
veloped in the lower extremities. He sub-
sequently became stuporous and began to
have generalized convulsions. At the local
hospital the convulsions could not be con-
trolled by the use of sedatives. Examination
of the spinal fluid was negative.

October, 1960

POISON CONTROL— ARENA

471

Several days before this child's admis-
sion, several members of his family had
had febrile episodes characterized by nau-
sea, vomiting and diarrhea, associated with
muscle pain. One sibling was ill at the
time. There was also the history that the
patient had been playing around a truck
used on the family's farm, and had fallen
from it, striking his head.

The past history was negative. The fam-
ily history revealed that a paternal cousin
had epilepsy.

Physical examination: The temperature
was 39.8 C, the pulse 140, the blood
pressure 106 systolic, 70 diastolic, respira-
tion 30 (Cheyne-Stokes). The patient was
a well developed, well nourished white male
in coma and having frequent generalized
convulsions. The pupils reacted sluggishly
to light. The liver was felt 2 cm. below the
right costal margin. The patient was coma-
tose, with flaccid extremities, and did not
respond to stimuli.

Accessory clinical findings: The hemoglo-
bin was 10.5 Gm., hematocrit 33 vol. per
cent, and the white blood cell count 25,000,
with 26 per cent stab cells and 20 per cent
polymorphonuclears. Urinalysis revealed a
1 plus reaction to protein. Stool examina-
tion revealed a 2 plus guaiac reaction. O.T.
skin test (1:1,000) was negative. Spinal
fluid examination and culture were also
negative. The urinary chlorides were with-
in normal limits. Blood chemistry deter-
minations were as follows : fasting blood
sugar 111 mg. per 100 ml., nonprotein ni-
trogen 25 mg. per 100 ml., sodium 124 mEq.
per liter, potassium 5.6 mEq. per liter,
chloride 85.1 mEq. per liter, carbon dioxide
combining power 19.8 mEq. per liter. Welt-
ma. in reaction was 2.5. Urine and blood cul-
tures were negative.

Hospital course: The child was placed on
intravenous fluids and was given barbit-
urates and paraldehyde for convulsions. A
tracheotomy was performed, and he was
placed in a respirator. Despite the history,
the possibility of intoxication was raised,
and after repeated questioning of the fam-
ily it was learned the Chlordane was kept
on the truck on which the patient had
played. On several previous occasions he
had been caught trying to play with the
container. Investigation disclosed that the
container had been opened and was almost
empty.

Since the ingestion had occurred the day

before admission, gastric lavage was not
done. Within the next few days the convul-
sions ceased and the sensorium cleared. The
patient was removed from the respirator
without resultant difficulty. Initially it was
difficult to control the sodium levels, but
this imbalance was corrected by large doses
of saline. The tracheotomy was removed on
the sixth day, and two days later the pa-
tient was discharged, feeling well.

A follow-up examination several weeks
later disclosed that his course continued to
be uneventful.

Comment (Chlorinated Insecticides)

Indane derivatives (Chlordane, Heptach-
lor, Aldrin, Dieldrin, Endrin, Diendrin)
are synthetic-fat soluble, but water insolu-
ble chemicals which, either singly or com-
bined in the form of dusts, wettable pow-
ders or solutions, are used as insecticides
for the control of flies, mosquitoes, and
field insects. Aldrin, the most toxic of these
agents, is two to four times as toxic in an-
imals as is Chlordane. The other derivatives
have intermediate toxicity. Symptoms can
occur in man after ingestion of, or skin
contamination by, 15 to 50 mg. per kilo-
gram of body weight. Acute poisoning from
ingestion, inhalation, or skin contamination
is characterized early by hyperexcitability,
tremors, restlessness, ataxia, and tonic and
clonic convulsions. Since in animals liver
function is impaired well below lethal
levels, the toxicity of these derivatives are
enhanced in human beings who have had
liver damage.

Treatment: If ingested, the material must
be removed from the gastrointestinal tract
by gastric lavage and saline cathartics such
as Epsom salts. Fats and oils, such as oil
purgatives, demulcents and evacuants, as
well as milk, should be avoided, because they
increase the rate of absorption of chlorin-
ated hydrocarbons. In the event of skin
contamination, prompt washing with soap
and water is required to prevent irritation
and reduce systemic absorption. If muscu-
lar twitching or tremors develop, phenobar-
bital sodium should be administered. For
treatment of convulsive states, the more
rapid, shorter-acting barbiturates such as
pentobarbital sodium are indicated. Main-
tain clear air passages and administer oxy-
gen. If liver or kidney damage is suspected,
a low fat, high carbohydrate and protein
diet should be prescribed, together with
other appropriate measures.

472

NORTH CAROLINA .MEDICAL JOURNAL

October, 1960

North Carolina Medical Journal

Owned and published by

The Medical Society of the State of North Carolina,

under the direction of its Editorial Board.

EDITORIAL BOARD
Wingate M. Johnson, M.D., Winston-Salem

Editor
Miss Louise MacMillan, Winston-Salem

Assistant Editor
Mr. James T. Barnes, Raleigh

Business Manager
Ernest W. Furgurson, M.D., Plymouth
John Borden Graham, M.D., Chapel Hill
G. Westbrook Murphy, M.D., Asheville
William M. Nicholson, M.D., Durham
Robert W. Prichard, M.D., Winston-Salem
Charles W. Styron, M.D., Raleigh

Address manuscripts and communications regarding
editorial matter to the
NORTH CAROLINA MEDICAL JOURNAL
300 South Hawthorne Road, Winston-Salem 7, N. C.
Questions relating to subscription rates, advertis-
ing, ect., should be addressed to the Business
Manager, 203 Capital Club Building, Raleigh, N. C.
All advertisements are accepted subject to the ap-
proval of a screening committee of the State
Journal Advei'tising Bureau, 510 North Dearborn
Street, Chicago 10, Illinois, and/or by a Committee
of the Editorial Board of the North Carolina Medi-
cal Journal in respect to strictly local advertising
accepted for appearance in the North Carolina
Medical Journal.

Annual subscription, $5.00 Single copies, 75^

Publication office: Carmichael Printing Co., 1309

Hawthorne Road, S.W., Winston-Salem 1, N. C.

OCTOBER, 1960

MEDICAL RESEARCH,
CHOKED BY DOLLARS

The October issue of Harper's Magazine
has a special supplement of eight articles
entitled "The Crisis in American Medicine."
None of the articles, to put it mildly, are
flattering- to the medical profession, but
some of them contain really constructive
criticism. In the most thought-provoking of
these, Mr. John M. Russell, president of the
Markle Foundation, is admittedly swim-
ming against the current when he questions
the popular idea that any medical problem
can be solved if only enough money is spent
for "research," and that the greater the
amount raised, the more quickly the answer
will be found.

Mr. Russell writes that for a long time
he had wanted to protest against the "mis-
placed enthusiasm of ill - informed but
enormously kindhearted people," which not
only has led to a terrific waste of both pub-
lic and private funds, but threatens to delay

rather than accelerate progress in medical
research. He had hesitated to speak up, be-
cause he knew that he would be branded as
a heretic if he hinted that more money for
research is available than can possibly be
used wisely. Furthermore, he was not a
scientist and did not have first-hand knowl-
edge of a long and eventually fatal illness.
After watching the person dearest to him
die slowly of cancer, however, and being
himself treated for the dread disease, he
thought that while he was still no scientist,
he could claim to have first-hand knowledge
of his subject.

Mr. Russell makes three points about
medical research: (1) That the conquest of
disease is very different from building an
atomic bomb; (2) That men, not money do
research; and (3) That freedom is as im-
portant for a research worker as for any-
one else.

The atomic bomb, he says, was the re-
sult of fitting together bits of knowledge
already available. On the other hand, in the
sciences we are in an earlier stage of ex-
ploration and discovery. The so-called "team
approach" to medical discovery is no sub-
stitute for individual intuition. He quotes
one frustrated scientist as saying, "You
can't make nine women pregnant and there-
by produce a baby in one month."

Mr. Russell comments that our Congress-
men have discovered that medical research
has as good political possibilities as agri-
culture, and that they should be made to
realize that their generosity with tax funds
may actually stifle progress. He states em-
phatically that money alone will not solve
our medical problems, and that already far
more funds are made available through the
various volunteer fund-raising agencies and
Congressional appropriations than can poss-
ibly be used wisely. Medical research
workers are being urged to accept more
money in grants than they need. As a re-
sult of the huge appropriations, scientists
are put under pressure to produce some evi-
dence of their activity in the form of papers
and progress reports. Furthermore the re-
search workers assume a moral obligation
to confine their energies to a particular
problem instead of following promising
trails in other fields.

One result of overemphasis on pure re-
search is that many good teachers are taken

October, 1960

EDITORIALS

473

from medical schools and put into labora-
tories. He quotes one medical educator as
saying: "Because we can't compete with
the salary scale and the superb laboratory
facilities that the government can offer,
many good men have been lost to medical
education and are being hoarded by the
government. This will eventually be re-
flected by a decrease in the standards of
medical school teaching."

Doubtless Mr. Russell has in his forth-
right comments spoken for many medical
educators, scientists, and thoughtful citi-
zens who have hesitated to question the
wisdom of thinking that all medical pro-
lems can be quickly solved by spending
enough money. May his wise counsel have
a salutary effect on the over-all problems of
research, teaching, and patient care. No
true humanitarian would want to see funds
for medical research cut off altogether — or
reduced too drastically — but there is a de-
sirable happy medium which should be
sought.

% ''fi *

IMAGINARY POVERTY

One of the most interesting features of
the British Medical Journal is the Corre-
spondence department. The British are
noted as letter writers, and the doctors are
no exception. The letters cover numerous
subjects, and many of them contain real
pearls of wisdom.

A good example is Dr. A. W. Beatson's
letter in the August 6 issue. The writer's
description of a condition familiar to al-
most everyone is so clear that it is quoted
verbatim :

There exists a common, well-defined mental
aberration which I have never seen reported. The
patient, who is tormented, has no insight, is not
amenable to reason, and, as there are two de-
lusional components, the condition qualifies as
a psychosis. I call it Imaginary Poverty.

The patient, whose finances are, in fact, ex-
tremely sound, and who spends lavishly on lux-
uries, believes he cannot afford necessities. The
second delusional aspect is an implied belief that
life on this earth will continue indefinitely, and
no capital must be realized for fear of compro-
mising the security of this interminable future.
The malady can afflict, of course, only the well-
to-do, but is not confined to any one social stra-
tum; incidence increases with age, and female
cases predominate, though they are probably not
more often afflicted than would be expected from
their preponderance in the older age-groups.
Often there are no dependants, and at demise

the State is the chief beneficiary . . .

... In general there is a readiness to spend
on material things and a reluctance to pay for
services and essentials, such as a good dietary . . .

The disease is to be distinguished from miser-
liness, or the enjoyable hoarding of riches with-
out delusion of poverty; and from avarice and
cupidity, both of which the Concise Oxford Eng-
lish Dictionary defines as "greed of gain" and
in which there is no disproportion of values;
parsimony, with which one associates the care-
ful deployment of available resources; the true
destitution of inevitable poverty; voluntary pov-
erty as practised by some religions; and the
fashionable poverty-sois-disant, or "one down-
manship."

A few case histories are given, of which
one will suffice:

An intelligent spinster dying of an obscure
bulbar palsy . . . knew the end was near. Her
assets were in excess of £20,000, but she died
disconsolate as I was unable to accede to her re-
quest for toilet-tissues "on the National Health". .
Dr. Beatson's closing sentence is referred
to our readers for possible answers:

"I know of no treatment for this illness
and would be interested to hear of its pre-
valence elsewhere."

EVANGELIST SAYS
WORLD END NEAR

The title of this editorial is taken from
headlines over a United Press story in the
Winston-Salem Sentinel for August 29.
Billy Graham was quoted as telling audi-
ences in Bern and in Zurich that the end of
the world is near: "Jesus Christ will come
soon and all of us should get ready."

It may seem out of place for a medical
journal to comment on this story, but such
statements may seriously disturb some emo-
tionally unstable persons. Children are
especially apt to be alarmed by the thought
of an impending "Judgment Day." Doubt-
less many older people can recall having
been frightened by the warning that the
world might end within the very near fu-
ture. And some adults as well are and have
been upset by similar prophecies.

Some of these immature people of all
ages may become so mentally upset as to
require medical advice. The physicians
called on to soothe the victims of such fears
may find help from the very same Gospel
chapters that are quoted by the modern
prophets. For example, Matthew 24:11 de-
clares : "And many false prophets shall
rise and deceive many." Certainly, during

474

NORTH CAROLINA MEDICAL JOURNAL

October, 1960

this century — and longer — numerous well
meaning but false prophets have deceived
many about the nearness of Doomsday. And
verse 26 of the same chapter asserts: "But
of that day and hour knoweth no man, no,
not the angels of heaven, but my Father
only."

Is it not a ! ittle presumptuous for any
mortal to claim to know more than the an-
gels of heaven?

PROJECT HOPE

Recently, as all readers of newspapers
know, the nation's drug manufacturers have
been severely criticized by the Kefauver
Committee and other self-appointed critics.
The following excerpt from a recent news
release of the People-to-People Health Foun-
dation, however, shows that they ara not
altogether heartless.

"Fifty-two of the nation's leading pre-
scription drug manufacturers have contri-
buted in excess of $780,000 in products and
cash to Project HOPE, according to Dr.
William B. Walsh, president of the People-
to-People Health Foundations, sponsor of
the Project. Over $100,000 of the companies'
contributions were in cash. Product values
were computed according to manufacturers'
wholesale prices.

"A part of President Eisenhower's Peo-
ple-to-People program, Project HOPE will
send a 15,000 ton hospital ship, the SS
HOPE I, to Southeast Asia on September
22. Staffed with American doctors, nurses,
and medical technicians, the floating med-
ical center will bring modern medical knowl-
edge and techniques to the medical and
health professions of newly developing
countries throughout the world.

" 'As a non-government program, Project
HOPE could only succeed with the coopera-
tion and backing of all segments of Amer-
ican society,' Dr. Walsh said. 'The response
of the American drug industry, many other
industries, businesses, and groups, Ameri-
can labor, and the American public is proof
that our confidence in the conscience of
American was warranted.' "

BLUE SHIELD
AND THE NEW CHALLENGE

The American doctor's eternal struggle to
preserve his professional freedom is now be-
ing waged in a new arena. Ten years ago, the
big question was whether medicine could
develop a viable prepayment program by its
own voluntary effort, aided by labor, man-
agement and local community leaders. The
alternative then was the threat of compul-
sory health insurance, governmental!}- oper-
ated and controlled.

The product of our initiative — and of the
people's tremendous response — is the vast
Blue Shield - Blue Cross complex, supple-
mented by a tremendous expansion of the
insurance industry's effort in this field.

Both the medically - sponsored nonprofit
plans and the commercial insurance pro-
grams are based upon the traditional pattern
of free choice of physician, fee-for-service,
and the private relationship of patient and
doctor.

In some segments of our economy today,
both labor and management are showing a
lively interest in providing medical care
through a "closed panel" program, in which
free choice would be limited, fee-for-service
would be replaced by salaries or capitation
payments, and the direct personal respon-
sibility of the physician would be subordin-
ated by collective controls.

The American Medical Association has
acknowledged the legitimacy of these altern-
ative programs and the right of the patient
to choose the pattern or plan through which
he wishes to prepay his medical care. This is
realism.

But it is also realistic for us physicians to
realize that ultimately we can preserve our
traditional pattern of medical service only
if our patients find that it meets their vital
needs better than any other program.

Our own Blue Shield Plans offer us the
best — and only — instrument through which
we can control the economy of medicine and
determine the shape of medical practice in
the future.

But Blue Shield is only an instrument, The
understanding, vision and leadership re-
quired to perfect this instrument — so that it
will serve satisfactorily the needs of our pa-
tients— must come from us, acting through
our county, state and national medical so-
cieties.

October, 1960

475

Presidents Message

The Medical Issue in Politics

Tuesday, November 8, being only a few
days away, it is most important that we in
medicine re-evaluate our stake, as well as
the medical stake of the American people,
in the upcoming election. The issues, party-
wise as pertain to medical care and the pro-
fession of medicine were clearly delineated
in the first Kennedy-Nixon national tele-
vision debate.

Mr. Nixon's expressed views supported
a type of federal medical aid legislation
more liberal than the currently passed
"Kerr Bill," which is as yet unimplemented
in this state. However, the Nixon type of
proposed federal medical aid although con-
siderably expensive tax-wise, does embody
the principles of prepayment insurance, op-
tional participation, free enterprise medi-
cine, with emphasis on state as opposed to
federal control.

Mr. Kennedy emphatically reiterated his
stand for total medical care for the reci-
pients of Social Security benefits. The An-
derson amendment to the "Kerr Bill", as
he proposes, embodies legislation adminis-
tered by the federal government under the
present federal Social Security system. One
reason advanced by Mr. Kennedy for his
support of this type legislation was that it
would not increase the federal taxload.
When asked about medical care for the mil-
lions of elder citizens not now under Social
Security, he replied that this legislation was
offered as an amendment to the "Kerr"
general federal medical aid bill then cur-
rently before the Senate. This implied Mr.
Kennedy's support, if not approval, of the
expensive "Kerr type" of legislation in
addition to federally administered "Forand
type" of legislation. Mr. Kennedy's worries
over the burden of taxation are inconsistent
with his means to achieve an end.

Let us analyze Mr. Kennedy's position as
outlined above. Obviously, his position on
medical care supports his avowed purpose
of expanding the functions of the federal
government at the expense of state and lo-
cal government. He is dedicated to the prin-
ciple that the provision of medical care is
a function of the federal government. Mr.
Kennedy proposes to finance this federal
medical care program by increased Social

Security taxation, one half of which is ex-
acted from the employer. Thus is evidenced
another of Mr. Kennedy's cardinal princi-
ples, the redistribution of national wealth
by taxation.

Now we should return to our major
premise, that he who votes also rules. The
past three or four decades of the twentieth
century have produced rapid and far-reach-
ing changes in the expectations and antici-
pations of both citizens and federal govern-
ment regarding medical care and the
organization and administrative methodol-
ogy of medical services. The advent and
rapid progress of the idea of prepaid hos-
pital and medical care insurance, along with
the emergence of identifiable, closely bonded
groups within society — that is, labor and
labor unions, veterans, armed services de-
pendents, federal employees, recipients of
Social Security, Senior Citizens, and so
forth — has done much to alter the structure
and methodology of administering medical
care. In this fertile field of rapid change
and turmoil, politicians and political par-
ties have found a new bonanza for beguil-
ing voters.

Medicine, that intangible commodity so
vital to the health and well-being of our
Nation, has been thrown into the game of
politics through no choice of the profession.
Practitioners of medicine now have a new
challenge and a new obligation. It must be
and is Medicine's duty to enter vigorously
into this new aspect of medicine in politics
in order to insure for the people of Ameri-
ca continuation of the high quality of med-
ical care to which they are entitled and ac-
customed. We can on longer stand idly by
while politicians and their allies determine
the future of medical care which is so vital
to our people. Political medicine is bad med-
icine— bad for the patient, bad for the doc-
tor, bad for the nation.

I strongly urge every doctor in this state
and in this nation to become participants
in the body politic. Register and vote, your-
self; insist that your immediate family
vote ; make sure your employees are regis-
tered and have an intelligent insight into
the issues at stake; identify yourself clear-
ly, but with reason, with the national and

476

NORTH CAROLINA MEDICAL JOURNAL

October. 1960

local candidates who support those princi-
ples which are productive of the best care
for the people of this country ; contribute
both financial assistance and your personal
time and influence to the campaigns of
your chosen candidates.

No group identifiable in American so-
ciety has the potential power to influence
political decisions as do doctors of medicine
in their daily contacts with individual pa-
tients. A remark here, a comment there,
the influence and persuasion of a well in-
formed wife, a few minutes spent daily in
persuasive discussion with influential pa-
tients— this is an opportunity to wield more
political influence, to the betterment of
mankind, than all the work of all of the
fully employed professional politicians.
Remember

HE WHO VOTES RULES HIM WHO
DOES NOT VOTE

Amos N. Johnson, M.D.

BULLETIN BOARD

COMING MEETINGS

State

University of North Carolina School of Medicine,
six - week postgraduate courses — Memorial Mission
Hospital, Asheville, beginning October 4; Grace
Hospital Nurses Home and Mimosa Golf Club, Mor-
ganton, beginning October 5.

Mecklenburg County Chapter of the North Caro-
lina Academy of General Practice, postgraduate
seminar with round table discussion — Hotel Char-
lotte, Charlotte, November 3.

Duke University postgraduate medical seminar
cruise to the West Indies — November 9-18.

Raleigh Academy of Medicine, Twelfth Annual
Medical and Surgical Symposium — Sir Walter Ho-
tel, Raleigh, October 27.

North Carolina Pediatric Society, Annual Meet-
ing— Greensboro, November 11-12.

Ninth Annual Gaston Memorial Hospital Sym-
posium— Gastonia, November 17.

University of North Carolina School of Medicine
Symposium — Chapel Hill, November 17-18.

AVestern North Carolina Regional Seminar on the
Care of the Severely Disabled, sponsored by the
North Carolina Society for Crippled Children and
Adults — Memorial Mission Hospital, Asheville, No-
venber 3.

North Carolina Academy of General Practice, An-
nual Meeting — Carolina Hotel, Pinehurst, November
27-30.

Regional and National

Southern Chapter, American College of Chest
Physicians, Seventeenth Annual Meeting— Statler-
Hilton Hotel, St. Louis, Missouri, October 30-31.

Southern Medical Association Annual Meeting —
St. Louis, Missouri, October 31-November 3.

Symposium on Pyelonephritis, held in conjunction
with the annual meeting of the Southern Medical
Association — St. Louis, November 2.

Annual Conference on Electrical Techniques in
Medicine and Biology — Sheraton-Park Hotel, Wash-
ington, D. C, October 31-November 2. (Address
Lewis Winner, 152 Westt 42nd Street, New York,
N. Y., for further information.)

American Medical Writers' Association — Morri-
son Hotel, Chicago, November 18-19.

Southeastern Region, College of American Path-
ologists and the Virginia Society of Pathologists —
John Marshall Hotel, Richmond, November 25-26.

Emory University Postgraduate Course in Oph-
thalmic Surgery — Grady Memorial Hospital, Atlan-
ta, Georgia, December 1-2.

Symposium on Urology for Practicing Physi-
cians— University of Virginia School of Medicine,

Southern Surgical Association, Annual Meeting
— Boca Raton, Florida, December 6-8.

International Clinical Postgraduate Program,
University of California Extension Division — Mex-
ico City, Acapulco, Guadalajara, January 9-20. (Ad-
dress requests for information to Thomas H. Stern-
berg, Assistant Dean for Postgraduate Medical
Education, University of California Medical Center,
Los Angeles 24.

New Members of the State Society

The following physicians joined the Medical So-
ciety of the State of North Carolina during the
month of September, 1960:

Dr. Cecil L. Barrier, Edward's Clinic (Toluca),
Lawndale; Dr. Joseph Jethro Allen, Box 707, War-
renton; Dr. J. Malcombe McDonald, Champion Pa-
per & Fibre Company, Canton, Dr. Robert Grant,
Waynesville; Dr. William Edmund Lassiter, 232
Hayes Road, Chapel Hill; Dr. William Brevard
Blythe, 211 McCauley Street, Chapel Hill; Dr. Jo-
seph Lawton Smith, Duke University Medical
Center, Durahm.

Dr. Jesse Graham Smith, Jr., 1020 Sycamore
Street, Durham; Dr. George Piercy Vennart, Dept.
of Pathology, UNC, Chapel Hill; Dr. Benjamin Earl
Britt, 1009 Stancil Drive, Raleigh; Dr. Odell C.
kimbrell, 226 Bryan Building, Raleigh; Dr. John
Richard Taylor, Box 289, Enka; Dr. Robert Tillman
Chambers, 54 Salem Street, Thomasville; Dr. Clif-
ford Newton Edwards, Bowman Gray, Winston-
Salem; Dr. William Burns Jones, Jr., S. Main
Street, Warrenton ; Dr. Charles Jefferson Wilson,
Spruce Street, Spruce Pine.

News Items from the University of
North Carolina Shool of Medicine

Two postgraduate courses in medicine, sponsored
by the University of North Carolina School of Medi-

October, 1960

BULLETIN BOARD

477

cine, will begin in October in Asheville and
Morganton.

The courses will consist of two lectures one day a
week over a six-week period.

The Asheville course, which begins October 4, is
co-sponsored by the Buncombe County Medical So-
ciety and the Morganton course, which begins
October 5, is co-sponsored by the Burke County
Medical Society.

All Asheville lectures will be given in the Bun-
combe County Medical Society Library at Mem-
orial Mission Hospital at 5 P.M. and 7:15 P.M.

The afternoon Morganton lectures will be given
at the Nurses' Home of Grace Hospital at 4:30
P.M. The 7:30 P.M. lectures will be given at the
Mimosa Golf Club.

The lecturers for these courses, in order of their
appearance are: Dr. Louis Krause, University of
Maryland School of Medicine; Dr. Albert
Mendeloff, Johns Hopkins School of Medicine; Dr.
Fred Ellis and Dr. Dan Martin, both of the Uni-
versity of North Carolina School of Medicine; Dr.
Ivan Brown, Duke University School of Medicine;
Dr. Eleanor Easley, University of North Carolina
School of Medicine; Dr. James Hughes, University
of Tennessee School of Medicine.

Both courses are acceptable for credit by the
American Academy of General Practice for the
number of hours attended by the individual
physician.

The first year class of the University of North
Carolina School of Medicine is composed of 69
students representing one third, or 33, of the state's
100 counties.

Of the entire first year class, a total of 57 stu-
dents took their pre-medical education at colleges
in this state; and 39 of them attended the Univer-
sity of North Carolina. The remaining 12 students,
including North Carolina residents, took their pre-
medical education at schools outside of the state.

The names of three new faculty members at the
University of North Carolina School of Medicine
were announced recently by Chancellor William
B. Aycock following approval by the UNC Board
of Trustees.

Their names and the institutions from which
they come are as follows: Edward Glassman,
assistant professor in biochemistry and nutrition.
City of Hope Medical Center, Duarte, California ;
George P. Vennant, associate professor in path-
ology, Columbia University; Paul A. Obrist,
assistant professor in psychiatry, Fels Research
Institute, Antioch, Ohio.

A new research laboratory primarily in a unique
colony of hemophilic dogs, the only such colony in
the world, was dedicated by the University of
North Carolina School of Medicine, Sunday, Sept.
25.

The new Francis Owen Blood Research Labora-
tory for the study of abnormalities of the blood,
was dedicated by the U. N. C. School of Medicine
on Sunday, September 25, Chapel Hill at the Uni-

versity Lake. The new laboratory a part of the
Medical School's Deparament of Pathology, will be
used primarily to house and study the colony of
hemophilic dogs.

District 12 of the University of North Carolina
Medical Alumni Association met at the Greensboro
Country Club in Greensboro on Tuesday, Sept. 20.

This district is composed of Guilford, Randolph
and Rockingham Counties. The District chairman,
Dr. Thomas A. Henson of Greensboro, presided.

Dr. W. Reece Berryhill. dean of the School of
Medicine, discussed the affairs of the Medical
School. Brief talks were made by Mr. Paul Schenck,
President of the Medical Foundation of N. C, Inc.
and Dr. John Rhodes. President of the U. N. C.
Medical Alumni Association.

Some 100 Tar Heel doctors, coaches, trainers,
and other interested persons attended a one-day
seminar at the University of North Carolina on
September 21 to hear lectures on the prevention and
management of athletic injuries.

The University of North Carolina School of
Medicine's Fourth Annual Symposium will be held
at Memorial Hospital in Chapel Hill on November
17 and 18.

This course in Gastroenterology will feature
small gronp teaching and panel discussions in
studying diseases causing primary or secondary
disturbances of digestive tract functions.

The Symposium will be staffed by the division of
Gastroenterology and the department of Surgery
of the University of North Carolina School of
Medicine, and guest participants.

The Symposium is tuition free.

News Notes from the Bowman Gray
School of Medicine of
Wake Forest College

Two of four exhibits submitted by the Depart-
ment of Pathology won national awards at the com-
bined annual meeting of the American Society of
Clinical Pathologists, College of American Patholo-
gists, and the Inter-Society Cytology Council. The
meeting was held from September 23 to October 2
at Chicago, Illinois.

A silver award in the original exhibit classifi-
cation went to Thomas B. Clarkson, Jr., D. V. M.,
associate professor of experimental medicine; Hugh
B. Lofland, Ph. D., assistant professor of biochem-
istry; R. W. Prichard, M. D. assistant professor of
Pathology; and Martin G. Netsky, M. D., professor
of neurology and neuropathology for their pre-
sentation of "Spontaneous Atherosclerosis in
Pigeons."

Dr. Robert P. Morehead's exhibit on "Tumors of
Salivary Glands" won a bronze award in the educa-
tional exhibit category. Dr. Morehead is chairman
of the Department of Pathology.

478

NORTH CAROLINA MEDICAL JOURNAL

October, I960

Eighty-eight pre-medical students from Wake
Forest College toured Bowman Gray School of
Medicine Friday, September 23, as a part of the
school's first Wake Forest Day. They saw exhibits
set up by various medical school departments and
the Bowman Gray chapter of the Student American
Medical Association.

In the spring- of 1959, the medical school and the
Alpha Epsilon Delta chapter at Wake Forest Coll-
ege sponored an all-college day in which students
from colleges and universities throughout the state
were invited to hear talks, see exhibits and medical
school facilities.

The plan now is to conduct on alternate years a
Wake Forest Day, inviting- Wake Forest students
only, and an all-college day.

J. D. Alexander, Jr. has joined the medical school
staff as director of the Office of Information. Mr.
Alexander, a staff reporter for the Winston-Salem
Journal and Sentinel for a year and a half, began
his duties in mid-September.

Dr. John R. Ausband, associate professor of Oto-
laryngology, participated in the September 14
postgraduate course of the North and South Caro-
lina E. E. N. T. Society held at the King Cotton
Hotel in Greensboro. His subject was "Some
Effects on the Lung Produced by Bronchography
Media."

Drs. Frank R. Lock and C. Hampton Mauzy,
professors of obstetrics and gynecology, attended
the annual meeting- of the American Association of
Obstetricians and Gynecologists at Hot Springs,
Virginia, September 8, 9, and 10. Dr. Lock present-
ed "Anomalies Following Rubella Infection During
Pregnancy."

Dr. Emery C. Miller, Jr., assistant professor of
internal medicine, read a paper before the third
annual Cape Fear Valley Hospital Medical Sym-
posium September 15 at Fayetteville, on "Current
Aspects of Diabetic Management."

Dr. Robert P. Morehead, chairman and professor
of the Department of Pathology, and Dr. Robert E.
Jones. Jr.. an intern in pathology, presented a paper
entitled "Intermediate Tumors of Salivary Glands"
September 27 at an assembly of the American
Society of Clinical Pathologists at Chicago, Illinois

Dr. William A. Wolff, associate professor of bio-
chemistry and toxicology, participated September
26 in the "Military Workshop for the Promotion of
Traffic Safety" at Fort Bragg. Dr. Wolff assisted
Winston-Salem Police Chief James I. Waller in a
breath analysis demonstration and reported on the
chemical test progra m in Winston-Salem and
Forsyth County.

Dr. Julius A. Howell, instructor in surgery (plas-
tic surgery), spoke September 25 and 26 at the

North Carolina Dental Society meeting at Winston-
Salem. His topics were "Intra-oral Carcinoma:
Diagnosis and Treatment" and "Benign Intra-oral
Lesions."

Coming Events

Oct. 3, 7:30 p.m.. Clinical Amphitheater : Herbert
M. Vann Memorial Lecture by Dr. Louis G. Welt,
Professor of Medicine at the University of North
Carolina School of Medicine on "Observations in
Experimental Potassium Depletion."

Oct. 10, 7:30 p.m.. Clinical Amphitheater: Bow-
man Gray Medical Society Program with Dr. John
A. Oates, Jr. of the Section on Experimental Thera-
peutics, National Heart Institute, National Institu-
tes of Health, speaking on "Inhibition of Amine
Biosynthesis in Man, A New Access to Therapy of
Hypertension."

Oct. 17, 7:30 p.m., Clinical Amphitheater: Bow-
man Gray Medical Society program with Dr. Wayne
Rundles, Professor of Medicine (Hematology) ;it
Duke University School of Medicine, speaking on
"Newer Nitrogen Mustard Compounds in Cancer
Chemotherapy."

Oct. 24, 7:30 p.m., Clinical Amphitheater: Pro-
gram by the Committee on Medical Education in
National Defense with Dr. Joseph Shaeffer, Direc-
tor of Medical Education, Santa Rosa Hospital, San
Antonio, Texas, speaking on "Principles in the
Management of Mass Injuries."

professional group on
Medical Electronics

North Carolina Chapter

A North Carolina Chapter of the Professional
Group on Medical Electronics of the Institute of
Radio Engineers has been organized. The function
of this group is to bring together engineers and
persons functioning in the medical sciences who
have common interests. It is expected that this as-
sociation will further the friendship between these
two groups and will bring about further develop-
ment in medical electronic research.

Any person in North Carolina who fits either of
these categ-ories and has an interest in medical
electronics is invited to join this group.

The first meeting of the 1960-1961 year will be
held at the cafeteria of the Bowman Gray School
of Medicine (N. C. Baptist Hospital) on Septem-
ber 23, 1960. A program interesting to both groups
is planned. All interested persons are invited to
this meeting whether members or not.

Dr. C. C. Lupton of Greensboro is president of
the chapter, and Dr. Jesse Meredith of Winston-
Salem is chairman of the Liaison Committee.

SOUTHERN MEDICAL ASSOCIATION
SYMPOSIUM ON PYELONEPHRITIS
Six of the nation's leading- experts on diagnosis
and treatment of pyelonephritis will participate in
a special Pyelonephritis Symposium to be held in
conjunction with the annual meeting of the South-
ern Medical Association in St. Louis on November
2, 1960.

October, 1960

BULLETIN BOARD

479

The Symposium, sponsored jointly by the South-
ern Medical Association and the Eaton Labora-
tories Division of The Norwich Pharmacal Com-
pany, will feature a round-table panel discussion
moderated by Dr. George Schreiner, associate pro-
fessor of medicine, Georgetown University, Wash-
ington, D. C.

Among the participants will be Dr. Fred K. Gar-
vey, professor of urology, Bowman Gray School
of Medicine, Winston-Salem.

ing Secretary, Committee on Cosmetics, American
Medical Association, 535 No. Dearborn Street,
Chicago 10, Illinois.

AMERICAN MEDICAL ASSOCIATION

The fourteenth clinical meeting of the American
Medical Association in Washington, November 28-
December 1, will offer a well-rounded, stimulating
scientific program designed to interest both family
physicians and speeialirts. The symposia, presenta-
tions, and discussions will stress the theme, "New
Developments in Old Diseases and Old Develop-
ments in New Diseases."

Participants will include proponents of both
sides where different views exist on the manage-
ment of a disease or medical condition. For ex-
ample, should tonsils be removed when mildly in-
volved or only when they are badly diseased ?

The patient's side will also be heard on one sym-
posium. Clarence B. Randall, an industrialist and
special assistant to President Eisenhower, will talk
on coronary disease from the patient's viewpoint.

The Problem of Management of Nodules, always
perplexing for both the specialist and the family
physician, will be discussed by three panels con-
cerned with breast nodules, the solitary pulmonary
nodule, and nodules of the neck.

Another panel will discuss Recent Advances of
the Use of Antibiotics and Steroids, and additional
symposia will cover areas in obstetrics-gynecology,
pediatrics, edema, cirrhosis and liver diseases,
renal problems, osteoporosis, thyrotoxicosis, eye
problems, orthopedic surgery and trauma, clinical
nutrition and bronchopulmonic disease.

The entire scientific program of the Clinical
meeting appears in the October 22 issue of the
Journal of the American Medical Association.

The Committee on Cosmetics of the American
Medical Association in cooperation with the
American Association for the Advancement of
Science will present a one-day symposium en-
titled "The Scientist's Contribution to the Safe
Use of Cosmetics." This program has been ar-
ranged at the invitation of the A.A.A.S. and will
be presented before the Pharmacy (NP) Section
at the Association's one hundred twenty-seventh
annual meeting in New York City en December
29, 1960.

The symposium will be divided into afternoon
and evening sessions and will include panel dis-
cussions at each session.

Further information on the symposium may be
obtained by writing to Dr. Joseph B. Jerome, Act-

American College of Chest Physicians

The American College of Chest Physicians will
hold its annual Interim Session at the Shoreham
Hotel in Washington, D. C. this November. The
scientific sessions will be held on Saturday and
Sunday, November 26 and 27. Monday, November
28, will be reserved for administrative sessions. Dr.
M. Jay Flipse, Miami, Florida, president of the
College, will preside.

Dr. Joseph W. Peabody, Jr., Washington, D.C.,
and his committee, have arranged a scientific pro-
gram of exceptional interest including symposiums
on Congenital Bronchopulmonary Disorders, the
role of Steroid Therapy in Chest Diseases, and Cur-
rent Therapeutic Issues.

A highlight of the program will be the Fireside
Conferences on Sunday evening, November 27. In
addition, there will be three round table luncheon
discussions on both Saturday and on Sunday. These
will feature prominent speakers discussing various
aspects of heart and lung diseases.

American College of Surgeons

Members of the medical profession are invited to
attend an instructive three-day Sectional Meeting
of the American College of Surgeons being held in
Birmingham, Alabama, January 16-18, 1961. Head-
quarters hotel for the meeting will be the Dinkler-
Tutwiler.

Dr. Arthur I. Chenoweth, associate professor,
Medical College of Alabama, chairman, and his Ad-
visory Committee on Local Arrangements, have
planned a program of interest to general surgeons
and to specialists.

The afternoon panel discussion is on urinary in-
continence in the female and will be moderated by
Dr. Conrad G. Collins, New Orleans. Collaborators
are LAMAN A. GRAY, Louisville, VAN SCOTT,
Birmingham, JOHN C. WEED, New Orleans, and
HAROLD L. GAINEY, Kansas City.

Additional information about program and re-
gistration may be obtained by writing to: William
E. Adams, M.D., Secretary American College of
Surgeons, 40 East Erie Street, Chicago 11, Illinois.

American Psychiatric Association

Philadelphia State Hospital on October 4 was
designated by the American Psychiatric Associa-
tion as the National Training Center for Remotiva-
tion — an unusual group discussion technique which
is aiding in the rehabilitation of mental patients.

Dr. Robert S. Garber, chairman of the A.P.A.'s
Committee on Remotivation, said the official desig-
nation was a logical one since the local hospital
has been the headquaters for the program from its
inception there in 1955.

480

NORTH CAROLINA MEDICAL JOURNAL

October, 1960

Dr. Garber noted that the Remotivation technique
is basically a group discussion program in which
psychiatric aides work with a small number of men-
tal patients to help stimulate — through planned
conversation sessions — a desire to return to reality.
Although not classed as therapy, the discussion
technique has been credited as a significant factor
in the removal of communication barriers which
work against the curative efforts of psychiatrist;.

He pointed out that the Remotivation program,
which is supported by funds from the Smith Kline
& French Foundation, has been introduced to some
600 nurses and aides in 35 hospitals by the Philadel-
phia training teams. These nurses and aids in burn
have carried the program to approximately 2200
other psychiatric personnel in about 100 additional
hospitals.

"The enormous success of and increasing interest
in Remotivation, due largely to the enthusiastic
support and development of the program by the
Philadelphia group, has now made it necessary to
establish regional training centers for a more prac-
tical application of instruction in the technique,"
Dr. Garber said.

So far, regional training centers have been estab-
lished at the Central State Hospital in Norman,
Okla.; Western State Hospital in Staunton, Ya.,
and the Essex County Overbrook Hospital in Cedar
Grove, N. J.

Dr. Garber paid particular tribute to Dr. Eugene
L. Sielke, superintendent of the Philadelphia State
Hospital, and Miss Helen Edgar, director of nurses,
for their leadership of the program. He also cited
the work of Mrs. Mertell Cameron, R. N., and
Walter Pullinger, psychiatric aide, who made up
the original Remotivation training team for the
hospital.

"With the designation of Philadelphia State Hos-
pital as the National Training Center for Remotiva-
tion, we feel that the project will forever be closely
indentified with its birthplace and that this recog-
nition will serve to remind us all of the outstanding
contributions the hospital has made to a better
understanding of mental illness," Dr. Garber added.

Association of
american medical colleges

The Association of American Medical Colleges
has begun seeking applicants for an unusual foreign
fellowship program which gives future American
doctors opportunity to study medicine in remote
areas of the world.

The program, begun last year as the Smith Kline
& French Foreign Fellowships, enables selected
medical students, who have finished either their
third or fourth year of training, to benefit from
unusual clinical experiences and to practice preven-

lauasol

October, 19G0

BULLETIN BOARD

481

tive medicine at outpost facilities in greatly differ-
ing societies and cultures.

Dr. Ward Darley, executive director of the A. A.
M. C, said application forms and brochures detail-
ing complete information on the SK&F Foreign
Fellowships have now been mailed to deans of all
U. S. medical schools.

Veterans Administration

Appointment of Dr. Robert I. McClaughry of the
National Academy of Sciences-National Research
Council as director of medical education service for
the Veterans Administration has been announced
by the VA.

In his new post at VA Central Office in Wash-
ington, D. C, Dr. McClaughry will coordinate pro-
grams making a major contribution to the trained
msdical manpower pool of the nation. One out of
each three new physicians and one of each 10 pro-
fessional nurses being produced by the United
States receive part of their education in VA hospi-
tals.

Appointment of Dr. Samuel C. Kaim as chief of
psychiatric research for the Veterans Administra-
tion was announced by the agency recently.

Dr. Kaim comes to VA Central Office in Wash-
ington, D. C, from the Coral Gables, Florida, VA
hospital, where he was chief of inpatient psychiatry
and neurology. He also was clinical assistant pro-

fessor of neurology at the University of Miami. In
his new post, he will coordinate the VA's largescale
cooperative research on newer drugs in the treat-
ment of mental illness, as well as the many indi-
vidual studies by VA personnel in the psychiatric
field.

The three top awards for scientific exhibits at
the Third International Congress of Physical Medi-
cine and Rehabilitation, held in Washington, D. C,
August 22-26, went to Veterans Administrations
psysicians.

Among the winners was Dr. Harry T. Zankel,
chief of physical medicine and rehabilitation at the
Durham, VA hospital, who won the Bronze Medal,
for his exhibit, "Stimulation Assistive Exercise in
Hemiplegia."

u. s. department of
Health, Education and Welfare

The proceedings of the Symposium on Phenom-
ena of the Tumor Viruses have been published by
the National Cancer Institute of the Public Health
Service, U. S. Department of Health, Education,
and Welfare. Sponsored by the Virology and
Rickettsiology Study Section of the National In-
stitutes of Health, the symposium was held March
25 and 26, 1960, in New York.

The symposium consisted of reports and panel
discussions on several phases of research in viruses

aquasol A

more readily, rapidly, completely reaches the
affected tissues because there is

"greater diffusibility of vitamin A from aqueous
dispersion into the tissues."1

aqiI3S0l A Capsules — the most widely used of all oral vitamin A

products, for these good reasons . . .

aqiieOUS vitamin A is more promptly, more fully,
more dependably absorbed and utilized.

natural vitamin A is more effective because it is
directly utilized physiologically.

Well tolerated — fish taste, odor and allergens are
removed by special processing.

economical — less dosage is needed and treatment time is sharply

reduced as compared to oily vitamin A.

capsules

three separate high
potencies (water-solubilized
natural vitamin A)
per capsule:

25,000 U.S. P. units

50,000 U.S. P. units

100,000 U.S. P. units

bottles of 100, 500 and 1000 capsules

Samples and literature available upon request.

u. s. vitamin & pharmaceutical corporation

482

NORTH CAROLINA MEDICAL JOURNAL

October, 19G0

and their relation to tumors. The proceedings are
published as National Cancer Institute Monograph
No. 4.

Dr. Joseph W. Beard of Duke University intro-
duced and edited the symposium. He also took part
in presenting reviews of research on the virus of
avian leukemia. Several papers presented findings
in studies with the polyoma virus. This virus
causes some 23 forms of cancer in mice and also
produces tumors in rats and hamsters. Other pa-
pers presented discussions on the properties of the
tumor viruses, host response, ultrastructure, and
contributions of tissue culture to the field of tumor
viruses.

National Cancer Institute Monograph No. 4 is
available from the Superintendent of Documents,
U. S. Government Printing Office, Washington 25.
D. C The price for a single copy is $3.00.

Four national courses to train medical and
health personnel for emergency services will be
held during the current fiscal year by the U. S.
Public Health Service and the Office of Civil and
Defense Mobilization.

Three of the courses will be for hospital admin-
istrators, registered nurses, and environmental
health personnel. The fourth is a repetition of
basic health mobilization training for physicians
and health-related professions which was intro-
duced to the public last April, May, and June.

Tuition and housing are provided without cost
to students and approximately one-half the neces-
sary travel expenses can be reimbursed through
OCDM student training expense funds. Enroll-
ments are limited to permit proper student-faculty
ratios. Applications should be made through State
Civil Defense Directors.

The proceedings of the Conference on Experi-
mental Clinical Cancer Chemotherapy have been
published by the National Cancer Institute of the
Public Health Service, U. S. Department of Health,
Education, and Welfare. The Conference assembled
in Washington, D. C, on November 11 and 12,
1959, and was sponsored by the Institute's Cancer
Chemotherapy National Service Center.

Published as National Cancer Institute Mono-
graph No. 3, the proceedings consist chiefly of
panel discussions on such subjects as: seeking
new structures of chemotherapeutic agents; design
and conduct of clinical investigations; use of drugs
in conjunction with surgical treatment for cancer:
and chemotherapy of specific forms of malignant
disease, such as leukemia, and cancer of the breast
and lung.

National Cancer Institute Monograph No. 3 is
available from the Superintendent of Documents,
U. S. Government Printing Office, Washington 25,
D. C. The single copy price is $2.00.

Bahamas Conferences

Irvin M. Wechsler, executive director, has an-
nounced the following schedule for the seventh
annua' s-jiies of Bahamas Conferences.
Tenth Medical Conference, November SO to Decem-
ber 10, 1960
Third Surgical Conference, December 28 to January

7, 19G1
Conference on Hypertension, January 8 to January

14, 1901
Third Serendipity Conference, January 22 to
Januarv 28, 1961

Baxter Laboratories, Inc., Buys New
IMant Site in South Carolina

Baxter Laboratories, Inc., has purchased a 47-
acre tract of land near Kingstree, South Carolina,
as a site for a new plant, William B. Graham,
president, announced today.

When finished, the plant will employ approx-
imately 100 people, Graham said. The facility will
manufacture intravenous solutions for hospital
use, blood equipment and pharmaceutical special-
ties.

"Psychiatric Newsreel" Released

A new "Psychiatric Newsreel," the second of
film reports depicting current developments in the
menial health field, has been released by Smith
Kline & French Laboratories, it was reported to-
day.

Jack Borland, director of SK&F's medical film
center, said the 30-minute, sound movie is avail-
able on a free-loan basis to professional audiences
at private, state and veterans mental hospitals
through local representatives of the Philadelphia
drug firm. The film, which depicts an unusual ap-
proach to mental health at Cassel Hospital in
England, as well as innovations in Kentucky and
California, also is available to the neuropsychia-
try divisions of general hospitals, Borland said.

The Cassel Hospital sequence, filmed at Ham
Common, Surrey, deals with a fully integrated
program of therapy for mothers which permits
them to bring their children with them when they
are admitted to the mental hospital. According to
Dr. Thomas Main, medical director at the hospital,
the program was designed to treat mothers with-
out impairing the mother-child relationship. The
experiment appears to speed the process of therapy
for the mothers, and initial fears that the children
might be adversely affected have proved ground-
less, Dr. Main said.

A mobile unit which brings "psychiatric first
aid" to the hill people of eastern Kentucky is the
film's second sequence. The unit, operated jointly
by the Eastern State Hospital, Lexington, and the
State Division of Community Services, provides
follow-up care for discharged mental patients,
limited diagnostic and treatment services as well

October, 1960

BOOK REVIEWS

483

as inservice training- of local teachers and nurses
and a public mental health education prog-ram.

The rinal portion of the "newsreel" depicts
group therapy being used in conjunction with the
rehabilitation of habitual criminals at the Cali-
fornia Medical Facility at Vacaville. Studies under
the program have shown that inmates who par-
ticipated in the therapy generally have become
more positive in their attitudes and have been
motivate toward work and self-improvement.

The second issue of "Psychiatric Newsreel" was
produced for SK&F by Ralph Lopatin Productions,
Philadelphia. It was written and directed by New-
ton E. Meltzer. The 16 mm. film may be obtained
from the Medical Film Center, Smith Kline &
French Laboratories, Philadelphia, Pa., as well as
from local representatives, Borland said.

in signatures. Best of all, these books are available
at low costs which puts them in the financial reach
of even medical students and house officers. These
editions cannot be recommended too highly.

BOOK REVIEWS

Experiments and Observations on the Gas-
tric Juice and the Physiology of Digestion.

By William Beaumont, M. D. 280 pages,
plus 40 pages of a biographical essay.
Price. $1.50. New York: Dover Publications,
Inc., 1959.

Classics of Medicine and Surgery. Collected
by C. N. B. Camac. 435 pages. Price, $2.25.
New York: Dover Publications, Inc., 1959.
Source Book of Medical History. Compiled
with notes by Logan Clendening, M. D.
Price, $2.75. New York: Dover Publications,
Inc., 1960.

Beaumont's original book, published in 1833, has
been reproduced in fascimile. A biographical essay,
"A Pioneer American Physiologist," by Sir
William Osier has been added in this edition.

Camac's "Classics of Medicine and Surgery" ap-
peared originally under the title "Epoch-making
Contributions to Medicine, Surgery and the Allied
Sciences." In this volume are the complete un-
abridged texts of 12 papers by Lister, Harvey,
Auenbrugger, Laennec, Jenner, Morton, Simpson
and Holmes. In addition there are biographical
sketches and lists of writings by these men.

Clendening's "Source Book of Medical History"
is a comprehensive survey of classical medical
writings covering medical history from the Egyp-
tian period to the discovery of the x-ray. Selections
from the writings of many famous men who con-
tributed greatly to our knowledge of medicine are
presented here, a few selections giving the original
papers in their entirety.

It is not the purpose of the reviewer to give a
critical analysis of these classics since their value
has been proven long ago. Dover Publications has
done a great service in reproducing thes volumes.
All of these books are unobtainable in their original
printings. Now they are available in paper-back
editions, printed on a good grade of papr with sewn

Mustard Plasters and Printer's Ink. By

Allen Moore, M.D. 262 pages. Price, $3.50
New York: Exposition Press, 1959.

The book, which contains a foreword by author
Tames A. (Tales of the South Pacific) Michener
and an introduction by former Comptroller Gen-
eral Lindsay C. Wan-en, is a kaleidoscope of a
country doctor's observations about people, places
and things, as first recorded in his column in the
Washington (North Carolina) Daily News.

In a relaxed and down-to-earth style Dr. Mooi-e
writes on subjects ranging from his foreign travels
to his experiences as a rural physician, providing
some "grass roots" writing that will find an en-
during place on the bookshelf for repeated brows-
ing.

A doctor since 1916, the author has written
many medical articles and has been doing a column
for the Washington Daily News since 1957. He
also was editor of "The Bucks County Medical
Journal" for 10 years.

New Film on Congestive Heart Failure Released

"Congestive Heart Failure" is a ten-minute 16-
mm sound film in color just released by Merck
Sharp & Dohme, Division of Merck & Co., Inc. The
film can be obtained for showing through the Film
Library of the American Medical Association,
Merck Sharp & Dohme sales branches, and the
MSD Film Library, Merck Sharp & Dohme, Phil-
adelphia 1, Pennsylvania. The company also has
available an illustrated brochure which contains
the entire narration script of the film.

Technical advice for "Congestive Heart Failure"
was furnished by Dr. William D. Stroud, profes-
sor emeritus in cardiology, Graduate School of
Medicine, University of Pennsylvania. The film
has the approval of the American Medical Asso-
ciation.

This film uses animation to acquaint the vic-
tims of this disease with the normal functions of
the heart and what happens to it under stress.

The film's broad appeal to the public is based
on its easy-to-understand explanation of the dis-
ease, its causes, and the remedial possibilities. The
film holds out the hope that, with proper care, a
patient with congestive heart failure has a good
prospect of returning to a relatively normal life.

"Congestive Heart Failure" is suitable for use
on television, for presentation to lay groups,
nurses, medical students and pharmacists, and
especially to patients suffering from the ailment.
It helps to allay fear of the condition by creating
a better understanding of its causes and informs
the audience that medical science now can do
something for victims of congestive heart failure.

484

NORTH CAROLINA MEDICAL JOURNAL

October, 1960

ifn iUrmnrtam

Abraham Hewitt Rose, M.D.

Whereas in the Province of God, Dr. Abraham
Hewitt Rose of Smithfiekl, North Carolina, our
brother and fellow member of the Johnston Coun-
ty Medical Society, has fallen asleep and passed
on to give an account of his work among us, there-
fore be it resolved that it is the desire of his fel-
low members to give an expression of their love,
respect and admiration for our departed brother.
We recognize in him a man of worth and a friend
of all; a doctor believed and trusted in a special
manner by his people, having served them for the
unusual period of more than fifty years; a good
attendant upon the meetings of this county med-
ical society, and an honorary member of the Med-
ical Society of the State of North Carolina; modest
and reserved in his demeanor and a lover of his
profession. Therefore be it

Resolved, that our sympathy goes out to his

family and his patients, and that a page in our

County Society records be ascribed to his memory.

E. H. Alderman, M.D., Pres.

Watson Wharton, M.D., Sect.

Milford Hinnant, M.D.

Whereas in the Province of God, Dr. Milford
Hinnant of Micro, North Carolina, our brother and
fellow member of the Johnston County Medical So-
ciety, has fallen asleep and passed on to give an
account of his work among us, therefore be it

Resolved that it is the desire of his fellow mem-
bers to give an expression of their love, respect,
and admiration for our departed brother. We re-
cognize in him a man of worth and a friend of all;
a doctor believed and trusted in a special manner
by his people, having served them for the unusual
period of more than fifty years; an honorary mem-
ber of the Medical Society of the State of North
Carolina; modest and reserved in his demeanor and
a lover of his profession. Be it further

Resolved that our sympathy goes out to his fam-
ily and hi=! patients, and that a page in our County
Society records be ascribed to his memory.

E. H. Alderman, M.D., Pres.
Watson Wharton, M.D., Sect.

Performed daily or regularly, exercise can bring
about loss of weight, it is reported in a recent
issue of Patterns of Disease, published by Parke,
Davis & Company for the medical profession.

Walking for one-half hour per day can result in
a weight loss of five pounds over a year. Similar-
ly, a half hour daily of handball or squash can,
over the same period, account for a 16-pound
weight loss, and splitting wood, for a 26-pound
loss.

Since the energy cost of exercise is proportional
to body weight, the overweight person will con-
sume more calories than the slender person per-
forming the same exercise. For example, a person
who is 20 per cent overweight will expend ap-
proximately 20 per cent more calories in walking,
playing handball or squash, etc. than the normal
or underweight person.

Winston- Salem

□ Asheville

•••

• •••□ a Greensboro
• « •• •

:* «n

• a Raleigh •

- ....

• Washington O TjP

P Charlotte

MATERNAL DEATHS REPORTED IN NORTH CAR0LINAx
SINCE JANUARY I, I960

Each dot represents one death

October, 1960

ADVERTISEMENTS

XXXVII

A NEW THERAPEUTIC ENTITY FOR DIARRHEA

LOMOTIL

SELECTIVELY LOWERS PROPULSIVE MOTILITY

LOMOTIL represents a major advance over the
opium derivatives in controlling the propulsive
hypermotility occurring in diarrhea.

Precise quantitative pharmacologic studies dem-
onstrate that Lomotil controls intestinal propulsion
in approximately Hi the dosage of morphine and
Vm the dosage of atropine and that therapeutic
doses of Lomotil produce few or none of the diffuse
untoward effects of these agents.

Clinical experience in 1,314 patients amply sup-
ports these findings. Even in such a severe test of
antidiarrheal effectiveness as the colonic hyperac-
tivity in patients with colectomy, Lomotil is effec-
tive in significantly slowing the fecal stream.

Whenever a paregoric-like action is indicated,
Lomotil now offers positive antidiarrheal control
. . . with safety and greater convenience. In addition,

LOW DOSAGE EFFECTIVENESS
OF LOMOTIL

EDjii in mg. per kg. of body weight in mice

I

16. S

■ 9.0

0.8

LOMOTIL MORPHINE

ATROPINE

as a nonrefillable prescription product, Lomotil
offers the physician full control of his patients'
medication.

PRECAUTION: While it is necessary to classify
Lomotil as a narcotic, no instance of addiction has
been encountered in patients taking therapeutic
doses. The abuse liability of Lomotil is comparable
with that of codeine. Patients have taken therapeu-
tic doses of Lomotil daily for as long as 300 days
without showing withdrawal symptoms, even when
challenged with nalorphine.

Recommended dosages should not be exceeded.

DOSAGE: The recommended initial dosage for
adults is two tablets (5 mg.) three or four times
daily, reduced to meet the requirements of each
patient as soon as the diarrhea is controlled. Main-
tenance dosage may be as low as two tablets daily.
Lomotil, brand of diphenoxylate hydrochloride
with atropine sulfate, is supplied as unscored, un-
coated white tablets of 2.5 mg., each containing
0.025 mg. (V>um gr.) of atropine sulfate to dis-
courage deliberate overdosage.

Federal Nar

otic Law.

EFFICACY AND SAFETY of Lomotil are indicated by its low median effective
dose. As measured by inhibition of charcoal propulsion in mice. Lomotil was
effective in about 1/n the dosage of morphine hydrochloride and in abour Vito the
dosage of atropine sulfate.

Subject to

Descriptive literature and directions for use available
in Physicians' New Product Brochure No. 81 from

g.d. SEARLEico.

P.O. Box 5110, Chicago 80, Illinois
Research in the Service of Medicine

XXXVIII

NORTH CAROLINA MEDICAL JOURNAL

October. 1960

more and more physicians are prescribing this triple sulfa

TERFONYL

Squibb Triple Sulfas (Trlsulfapyrlmldlnee)

Clinical experience continues to prove that
TERFONYL provides many special advantages
fundamental to successful antibacterial therapy.

specificity for a wide range of organisms superinfection rarely
encountered soluble in urine through entire physiologic pH range
• minimal disturbance of intestinal flora excellent diffusion through-
out tissues readily crosses blood -brain barrier ' sustained
therapeutic blood levels extremely low incidence of sensitization

SUPPLY: Tablets, 0.5gm. • Suspension, raspberry flavored, 0. 5 gm. per teaspoonful (5ce.).

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October, 1960

ADVERTISEMENTS

XXXIX

an added measure

of protection in your
treatment of
upper respiratory disorders

TABLETS (new!) and LIQUID

®^B

In new

raspberry
flavored

iS0fl wt

tablets and

^*rv

pleasant
tasting
liquid
form.

Supplied:
Liquid in 4 ounce
and pint bottles.
Tablets, bottles
of 50 and 100.

SULTUSSIN triple sulfonamides add their antibacterial
power to your choice of antibiotic to ... .

help prevent and clear up secondary infections
faster and more effectively

avert the dangers of rheumatic fever, nephritis,
otitis media and other complications

SULTUSSIN simultaneously affords maximum relief from
sneezing, stuffed or runny nose, cough, wheezing, malaise,
slight fever, and other distressing symptoms of the severe
common cold, coughs, influenza, etc.

antibacterial chemoprophylaxis • expectorant
antiallergic • bronchodilator • antispasmodic

Sulfadiazine

Sulfamerazine . . . .
Sulfamethazine . . .
Pyrilamine Maleate .
Phenyltoloxamine

Dihydrogen Citrate
Glyceryl Guaiacolate .
Ephedrine Sulfate . .

Each tablet
provides:
0.083 Gm.
0.083 Gm.
0.083Gm.
3.125 mg.

3.125 mg.

25.0 mg.

2.5 mg.

Each teaspoonful
(5 cc.) provides:
0.166Gm.
0.166Gm.
0.166Gm.
6.25 mg.

6.25 mg.

50.0 mg.

5.0 mg.

THE TlLDEN COMPANY • NEW LEBANON, N. Y.
Oldest Manufacturing Pharmaceutical House in America • Founded 1824

XL

NORTH CAROLINA MEDICAL JOURNAL

October, 1960

Use of SARDO in 118 dermatological patients to relieve
dry, itchy, scaly, fissured skm achieved these excellent
results:

CASES AFTER SARDO*

Excellent Good Poor

1
2

49 Senile skin 32 13
26 Dry Skin in younger

patients (diabetes, etc.) 14 11

20 Atopic dermatitis 8 10

13 Actinic changes 9 4 -

10 Ichthyosis 3 4 3

Skin Conditions Benefited No Benefit

20 Nummular dermatitis 19 1

10 Neurodermatitis 10 —

u; .f

:;i:r
Sardo

m

Santo

1

S

SARDO acts'2 to (A) lubricate and soften skin, (B) replenish natural
emollient oil, (C) prevent excessive evaporation of essential moisture.

SARDO releases millions of microfine water-miscible globules to pro-
vide a soothing suspension which enhances the efficacy of your other
therapy.

SARDO is pleasant, convenient, easy to use; non-sticky, non-sensitiz-
ing. Bottles of 4, 8 and 16 oz.
for SAMPLES and complete reprint of Weissberg paper, please write . . .

1. Weissberg, G.t
Clin. Med., June
1960.

2. Spoor, H. J.:
N. Y.St. J. Med.,
Oct. 15, 1958.

'patent pending
T.M. ©1960

SardeCLU, InC. 75 East 55th Street, New York 22, N. Y.

October, 1960

ADVERTISEMENTS

XLI

for bacterial pneumonias

capsules

The Original Tetracycline Phosphate Complex

U. 5. PAT. HO. 2,791,609

effective control of pathogens... with an unsurpassed record of safety and tolerance

BRISTOL LABORATORIES, SYRACUSE, NEW YORK U BRISTOL

SUPPLY: TETREX Capsules— tetracycline phosphate
complex-each equivalent to 250 mg. tetracycline HCI
activity. Bottles of 16 and 100.
TETREX Syrup— tetracycline (ammonium polyphosphate
buffered) syrup-equivalent to- r25 mg. tetracycline HCI
activity per 5 ml. teaspoonful. Bottles of 2 fl. oz. and 1 pint.

XLII

NORTH CAROLINA MEDICAL JOURNAL

October, 1960

To the relief of musculoskeletal pain,

new MEDAPRIN*

adds restoration of function

Analgesics offer temporary relief of musculo-
skeletal pain, but they merely mask pain rather
than getting at its cause. New Medaprin, in
addition to bringing about prompt subjective
improvement, promotes the restoration of normal
function by suppressing the inflammation that
causes the pain.

Medaprin, Upjohn's new analgesic-steroid com-
bination, contains aspirin plus Medrol,** the
corticosteroid with the best therapeutic ratio in
the steroid field.* Instead of suffering recurrent
discomfort because of the "'wearing off" of
analgesics, the patient on Medaprin experiences
a smooth, extended relief and more normal
mobility.

Indications: Medaprin is indicated in mild-to-
moderate rheumatic and musculoskeletal condi-

tions, including rheumatoid arthritis, deltoid
bursitis, low back pain, neuralgia, synovitis,
fibromyositis, osteoarthritis, low back sprain,
traumatic wrist, sciatica, and "tennis elbow."
Dosage: The recommended dosage is 1 tablet
q.i.d. The usual cautions and contraindications
of corticotherapy should be observed.
Supplied: In bottles of 100 and 500.
Formula: Each Medaprin tablet contains

• 300 mg. acetylsalicylic acid, for prompt
relief of pain

• 1 mg. Medrol, to suppress the causative
inflammation

• 200 mg. calcium carbonate, as buffer

* ••

TRADEMARK TRADEMARK, REG. U.S. PAT. OFF. — METHTLP'

fRATlO OP DESIRED EPPECTS TO UNDESIRED EFFECTS

SOLONE, UPJOHN

The Upjohn Company, Kalamaioo, Michigan

Upjohn

October, 1960

ADVERTISEMENTS

Fai

Change

Rain

Stormy

:.yi

~ ~~ ~ B~

"the G-I tract
is the
barometer
of the mind

Belbarb

soothes the agitated mind

and calms the G-I spasm

through the central effect

of phenobarbital and the

synergistic action of

fixed proportions

of natural belladonna

alkaloids on the

gastrointestinal tract.

>)

BELBARB

SEDATIVE ANTISPASMODIC

20 years of clinical satisfaction
Belbarb No. 1; Belbarb No. 2; Belbarb Elixir; Belbarb-B

CHARLES C'

HASKELL

>& COMPANY, Richmond, Virginia

"V7-v

XLIV

NORTH CAROLINA MEDICAL JOURNAL

October, 1960

no irritating crystals- uniform concentration in each drop^
STERILE OPHTHALMIC SOLUTION

NEO-HYDELTRASOL

PREDNISOLONE 21- PHOSPKATE-NEOMYCIN SULFATE

2,000 TIMES MORE SOLUBLE THAN PREDNISOLONE OR HYDROCORTISONE

"The solution of prednisolone has the

advantage over the suspension in that no

crystalline residue is left in the patient's

cul-de-sac or in his lashes .... The other

advantage is that the patient does not have to

shake the drops and is therefore sure of

receiving a consistent dosage in each drop."2

1 Lippmann. 0.. Arch Ophth. 57:339. March 1957.

2 Gordon. DM.: Am J. Ophth. 46:740. November 1958.
supplied: 0.5% Sterile Ophthalmic Solution NEO-
HYDELTRASOL (with neomycin sulfate) and 0.5% Sterile
Ophthalmic Solution HYDELTRASOL'. In 5 cc. and 2.5 cc
dropper vials Also available as 0.25% Ophthalmic
Ointment NEO-HYDELTRASOL (with neomycin sulfate)
and 0.25% Ophthalmic Ointment HYDELTRASOL.

In 3.5 Gm. tubes.

HYDELTRASOL and NEO-HYDELTRASOL are trademarks of Merck 8 Co.. Inc.
0S^ MERCK SHARP S DOHME Division of Merck £ Co . Inc.. Philadelphia 1, Pa.

October, 1960

ADVERTISEMENTS

XLV

Use of pHisoHex for washing the skin aug-
ments any other therapy for acne — brings
better results. Now, pHisoAc Cream, a new
acne remedy for topical application, sup-
presses and masks lesions — dries, peels and
degerms the skin. Together, pHisoHex and
pHisoAc provide basic complementary topical
therapy for acne.

pHisoHex, antibacterial detergent with 3 per
cent hexachlorophene, removes soil and oil
better than soap — provides continuous de-
germing action when used often. pHisoHex is
nonalkaline, nonirritating and hypoallergenic.

When pHisoAc Cream is used with pHisoHex
washings, it unplugs follicles, helps prevent

development of comedones, pustules and
scarring. New pHisoAc Cream is flesh-toned,
not greasy. It contains colloidal sulfur 6 per
cent, resorcinol 1.5 percent, and hexachloro-
phene 0.3 per cent in a specially prepared
base. pHisoAc is pleasant to use.

A new "self-help" booklet, Teen-aged? Have
acne? Feel lonely?, gives important psycho-
logic first aid for patients with acne and
describes the proper use of pHisoHex and
pHisoAc. Ask your Winthrop representative
for copies.

pHisoAc is available in 1V2 oz. tubes and
pHisoHex is available in 5 oz. plastic squeeze
bottles and in bottles of 16 oz.

pHisoHex and pHisoAc for acne

^ trademark

trademark

' LABORATORIES |
New York 18. N. Y.

XI.YI

NORTH CAROLINA MEDICAL JOVRNAI

October, 1960

a promise fulfilled

yvfckTa

All corticosteroids provide symptomatic control in rheumatoid arthritis, inflammatory derma-
toses, and bronchial asthma. They differ in the frequency and severity of side effects. Introduced
in 1958, Aristocort Triamcinolone bore the promise of high efficacy and relative safety.
Physicians today recognize that the promise has been fulfilled ... as evidenced by the high rate
of refilled Aristocort prescriptions.

&

CO

I Triamcinolone LEDF.RLE

iLEDERLE LABORATORIES, A Division of AMERICAN CYANAMID COMPANY, Pearl River, N.Y.

October, 1960

ADVERTISEMENTS

XLVII

Squibb Announces

new chemically improved penicillin
which provides the highest blood
levels that are obtainable with oral

penicillin

therapy

As a pioneer and leader in penicillin therapy *
for more than a decade, Squibb is pleased
to make Chemipen, a new . chemically im-
proved oral penicillin, available for clinical use.

With Chemipen it becomes possible as well as
convenient for the physician to achieve and main- ' «
tain higher blood levels — with greater speed — than
those produced with comparable therapeutic doses of
potassium penicillin V. In fact, Chemipen is shown to
have a 2:1 superiority in producing peak blood levels
over potassium penicillin V.*

Extreme solubility may contribute to the higher blood
levels that are so notable with Chemipen.* Equally nota-
ble is the remarkable resistance to acid decomposition
(Chemipen is stable at 37°C. at pH 2 to pH 3), which
in turn makes possible the convenience of oral treatment.

And the economy for your patients will be of
particular interest- — Chemipen costs no more
than comparable penicillin V preparations.

Dosage: Doses of 125 mg. (200,000 u.l or

250 mg. (400,000 u. ) , t.i.d., depending on the

severity of the infection. The usual precautions

my must be carefully observed with Chemipen, as with

all penicillins. Detailed information is available on

request from the Professional Service Department.

Supply: Chemipen Tablets of 125 mg. (200.000 u.) and
250 mg. (400,000 u.), bottles of 24 tablets. Chemipen
Syrup (cherry-mint flavored, nonalco- SQUIBB
holic ) , 125 mg. per 5 cc, 60 cc. bottles. .^^^

mm

'Knudsen. E. T. and Rolinson, G. N.: ^Ss*

Lancet 2: 1 105 (Dec.19) 1959. iSSrHSii.. pl&Thp^,

XLVIII

NORTH CAROLINA MEDICAL JOURNAL

October, 1960

'B.W. & Co.' 'Sporin' Ointments

rarely sensitize . . .
give decisive bactericidal action
for most every topical indication

'CQRTISPORIN'

r

brand Ointment

® Broad-spectrum antibac-
terial action— plus the
soothing anti-inflam-
matory, antipruritic ben-
efits of hydrocortisone.

'POLYSPORIN'

brand Antibiotic Ointment

A basic antibiotic com-
bination with proven
effectiveness for the
topical control of gram-
positive and gram-nega-
tive organisms.

Contents per Gm.

'Polysporin'3

'Neosportn'®

'Cortisporin'®

'Aerosporin'® brand
Polymyxin B Sulfate

10,000 Units

5,000 Units

5,000 Units

Zinc Bacitracin

500 Units

400 Units

400 Units

Neomycin Sulfate

—

5 mg.

5 mg.

Hydrocortisone

—

10 mg.

Supplied:

Tubes of 1 oz.,

l/2 oz. and l/a oz.

(with ophthalmic tip)

Tubes of 1 oz.,

Vz oz. and % oz.

(with ophthalmic tip)

Tubes of Vz oz. and

Va oz. (with

ophthalmic tip)

BURROUGHS WELLCOME & CO. (U.S.A.) INC., Tuckahoe, New York

October, 1960

ADVERTISEMENTS

XLIX

contain

the
bacteria-prone

cold

inner
protection
with...

CTriacetyloIeandomycin, Triaminic® and Calurin®)

safe antibiosis

Triacetyloleandomycin, equivalent to oleandomycin 125 mg.
This is the URI antibiotic, clinically effective against certain
antibiotic-resistant organisms.

fast decongestion

Triaminic®, 25 mg., three active components stop running noses.
Relief starts in minutes, lasts for hours.

well-tolerated analgesia

Calurin®, calcium acetylsalicylate carbamide equivalent to
aspirin 300 mg. This is the freely-soluble calcium aspirin that
minimizes local irritation, chemical erosion, gastric damage.
High, fast blood levels.

Tain brings quick, symptomatic relief of the common cold
(malaise, headache, muscular cramps, aches and pains) espe-
cially when susceptible organisms are likely to cause secondary
infection. Usual adult dose is 2 Inlay-Tabs, q.i.d. In bottles of 50.
IJ only. Remember, to contain the bacteria-prone cold... Tain.

SMITH-DORSEY • Lincoln, Nebraska
a division of The Wander Company

NORTH CAROLINA MEDICAL JOURNAL October, 1960

Major Hospital Policy

Pays up to $10,000.00 for each member of your family,
subject to deductible you choose

Deductible Plans available:
$100.00
$300.00
$500.00

Business Expense Policy

I

Covers your office overhead while you
are disabled, up to $1,000.00 per month

■i.

approved by

I
The Medical Society of North Carolina |

for Its Members

I
§

Write or Call |

for information 4,

Ralph ]. Golden Insurance Agency

I
i

%

Ralph J. Golden Associates Henry Maclin, IV

Harry L. Smith John Carson

108 East Northwood Street

Across Street from Cone Hospital

GREENSBORO, N. C.

Phones: BRoadway 5-3400 BRoadway 5-5035

f

.

8SSM

October, 1960

ADVERTISEMENTS

I.I

Sterazolidin

brand of prednisone-phenylbutazone

Even in the more transient rheumatic
disorders, an anti-inflammatory effect
more potent than that provided by aspirin
is often desirable to hasten recovery
and get the patient back to work.
By combining the anti-inflammatory
action of prednisone and phenylbutazone,
Sterazolidin brings about exceptionally
rapid resolution of inflammation with relief
of symptoms and restoration of function.
Since Sterazolidin is effective in low
dosage, the possibility of significant
bypercortisonism, even in long-term
therapy, is substantially reduced.

.Availability: Each Sterazolidin® oapsule contains prednisone
1.28 mg,; Butazolidin®, brand of phenylbutazone, 50 mg.;
dried aluminum hydroxide gel 100 mg.; magnesium
trisilieate 150 mg.; and bomatropine methylbromide 1.25 mg.
Bottles of 100 capsules.

Getgy, Ardsley, New York

Geigy

LI1

NORTH CAROLINA MEDICAL JOURNAL

October, 1960

m common

Gram-positive

infections

due to

susceptible

organisms

YOU CAN

COUNT ON

•■5,

TAG

(triacetyloleandomycinl

even

in many

resistant

Staph*

1,928 published cases in the two years since
TAO was released for general use show:

94.3% effectiveness in respiratory infections (617 cases
including tonsillitis, staphylococcal and streptococcal pharyngi-
tis, bronchitis, infectious asthma, broncho- pneumonia, lobar
pneumonia, bronchiectasis, lung abscess, otitis.)

You can count on TAO.

92% effectiveness in skin and soft tissue infections (900

cases including pyoderma, impetigo, acne, infected skin disor-
ders, wounds, incisions and burns, furunculosis, abscess, celluli-
tis, chronic ulcer, adenitis.) You can count on TAO.

87.1% effectiveness in genitourinary infections (349

cases including urethritis, cystitis, pyelitis, pyelonephritis, orchi
tis, pelvic inflammation, acute gonococcal urethritis, lympho
granuloma venereum.) You can count on TAO

75.8% effectiveness in diverse infections (62 cases indud

ing fever of undetermined origin, peritoneal abscess, osteitis
periarthritis, septic arthritis, staphylococcal enterocolitis, gas
troenteritis, carriers of staphylococci.) You can count on TAO

95.6% of 1,928 cases free of side effects— jn the remain

ing 4.4%, reactions were chiefly mild gastrointestinal disturb
ances which seldom necessitated discontinuance of therapy

Mn 884 of 1,928 cases the causative organisms were mostly
staphylococci. The majority of clinical isolates were found to be
resistant to at least one of the commonly used antibiotics and
many patients had failed to respond to previous therapy with one
or more antibiotics. TAO proved 93.4% effective in these 884
cases.
Complete bibliography available on request.

DOSAGE: varies according to severity of infection. Usual adult

dose-250 to 500 mg. q.i.d. Usual pediatric dose: 3-5 mg./lb.

body weight every 6 hours.

NOTE: In some children, when TAO was administered at considerably
higher than therapeutic levels for extended periods, transient-jaundice
and other indications of liver dysfunction have been noted. A rapid and
complete return to normal occurred when TAO was withdrawn.

SUPPLY: TAO CAPSULES-250 mg. and 125 mg., bottles of 60.
TAO ORAL SUSPENSION -125 mg. per 5 cc. when reconstituted,
palatable cherry flavor, 60 cc. bottles. TAO PEDIATRIC DROPS-
100 mg. per cc. when reconstituted, flavorful; special calibrated
dropper, 10 cc. bottles. INTRAMUSCULAR or INTRAVENOUS -
10 cc. vials, as oleandomycin phosphate.

OTHER TAO FORMULATIONS ALSO AVAILABLE: TAO®-AC (Tao, analgesic,
antihistamine compound! capsules, bottles of 36. TAOMID* (Tao with
Triple Sulfas)- tablets, bottles of 60. Oral Suspension-60 cc. bottles.

For nutritional support VI R A vitamins and Minerals

Formulated from Pfizer's line of fine pharmaceutical products.

New York 17, N.Y.

Division, Chas. Pfizer & Co., Inc.

Science for the World's Well-Being"1

October, 1960

ADVERTISEMENTS

LIII

Bed of Digitalis purpurea
with Campanula (Canterbury Bells.! in foreground

Not far from here are manufactured

from the powdered leaf

PiL Digitalis (Davies, Rose)

0.1 Gram (lV2 grains) or 1 U.S.P. Digitalis Unit.

They are physiologically standardized,

with an expiration date on each package.

Being Digitalis in its completeness,

this preparation comprises the

entire therapeutic value of the drug.

It provides the physician with a safe and effective

means of digitalizing the cardiac patient

and of maintaining the necessary saturation.

Security lies in prescribing the

"original bottle of 35 pills, Davies, Rose."

Clinical samples and literature sent to physicians on request

Davies, Rose & Co., Ltd.

Boston 18, Mass.

.IV

NORTH CAROLINA MEDICAL JOURNAL

October, 1960

IN GOLDS AND SINUSITIS-

THE RIGHT AMOUNT OF "INNER SPACE

RIGHT AWAY

Cjljintl

l/lOP LABORATORIES

New York 18, N. Y.

NEO-SYNEPHRINE

(Brand of phenylephrine hydrochloride)

hydrochloride

Neo-Synephrine hydrochloride relieves the boggy
feeling of colds immediately and safely, without
causing systemic toxicity or chemical harm to nasal
membranes. Turbinates shrink, sinus ostia open,
ventilation and drainage resume, and mouth-breath-
ing is no longer necessary.

Gentle Neo-Synephrine shrinks nasal membranes
for from two to three hours without stinging or
harming delicate respiratory tissues. Post-thera-
peutic turgescence is minimal. Neo-Synephrine does
not lose its effectiveness with repeated applications
nor does it cause central nervous stimulation, jitters,
insomnia or tachycardia.

Neo-Synephrine solutions and sprays produce shrink-
age of tissue without interfering with ciliary activity
or the protective mucous blanket.

For wide latitude of effective and safe treatment,
Neo-Synephrine hydrochloride is available in nasal
sprays for adults and children; in solutions from

NASAL SOLUTIONS AND SPRAYS soluble jelly.

October, 1960

ADVERTISEMENTS

LV

How to be
Carefree
Without
Hardly
Trying • • .

It really takes a load off your mind. . .
to know that you are protected from
loss of income due to illness or accident'

"Dr. Carefree" has no 30-day
sick leave ... no Workmen's
Compensation . . . BUT he has a
modern emergency INCOME PROTEC-
TION PLAN with Mutual of Omaha.

When he is totally disabled by accident or sickness covered by this plan, this plan
will give him emergency income, free of Federal income tax, eliminating the night-
mare caused by a long disability.

Thousands of members of the Medical Profession are protected with Mutual of Oma-
ha's PROFESSIONAL MEN'S PLAN, especially designed to meet the needs of the
profession.

If you do not already own a Mutual of Omaha INCOME PROTECTION PLAN, get in
touch now with the nearest General Agent, listed below. You'll get full details, with-
out obligation.

OF OMAH

Largest Exclusive Health and Accident Company in the World.

G. A. RICHARDSON, General Agent
Winston-Salem, N. C.

J. A. MORAN, General Agent
Wilmington, N. C.

J. P. GILES, General Agent
Asheville, N. C.

LVI

NORTH CAROLINA MEDICAL JOURNAL

October, I960

October, 1960

ADVERTISEMENTS

LVII

WHEN

THE PATIENT

WITHOUT

ORGANIC DISEASE

COMPLAINS OF

CONSIDER

L NEOCHOLAN*

Your patient will often respond promptly to Neocholan therapy. It greatly increases the flow of
thin, nonviscid bile and corrects biliary stasis by flushing the biliary system. It also relaxes intesti-
nal spasm, resulting in an unimpeded flow of bile and pancreatic juice into the small intestine.
Neocholan helps to promote proper digestion and absorption of nutrients. It also encourages
normal peristalsis by restoring intestinal tone.

Eachtabletprovides: Dehydrocholic Acid Compound.
P-M Co. 265 mg. (Dehydrocholic Acid, 250 mg.);
Homatropine methylbromide 1 .2 mg.; Phenobarbital
8.0 mg. Supplied in bottles of 100 tablets.

PITMAN-MOORE COMPANY

DIVISION OF ALLIED LABORATORIES, INC.
INDIANAPOLIS, INDIANA

LVIII

NORTH CAROLINA MEDICAL JOURNAL

October, I960

For Your Personal Pension Plan

The special features of the New England Life
contract will serve you to advantage

Recently we have run ads in this Journal and pointed out the new privileges to be
available to you and other professional practitioners in the formation of individual
retirement programs. We described the flexible change of plan clause in our policies,
and the special techniques and contracts developed in connection with Corporate
Pension Plans, pointing out that those features and services could well be applicable
to you personally.

The experience and services of our Company and Agency are available to you in con-
nection with your personal life insurance and retirement programs, regardless of
and independent of the Smothers, Keogh-Simpson Legislation that may be passed.
Any retirement program you may now initiate through New England Life can be
adapted through such legislation as may be passed in the future.

Again we list below our Agency Associates whose knowledge and experience
serve you well.

AGENCY ASSOCIATES

may

ASHEVILLE

Henry E. Colton, C.L.U.

CHARLOTTE

A. J. Beall
Richard Cowhig
Calbert L. Dings
T. Ed Thorsen, C.L.U.

DURHAM

R. Kennon Taylor, Jr., C.L.U.

GASTONIA

Hugh F. Bryant

HICKORY

O. Reid Lineberger

HIGH POINT

Walter M. Bullock
George P. Clark

RALEIGH

John Cates

Ryland Duke

Carlyle Morris

Reid S. Towler, C.L.U.

REIDSVILLE

James E. Everette

STATESVILLE

Tom White
WILMINGTON

Meares Harriss, C L.U.
Alex Urquhart, C.L.U.

WILSON

B. B. Plyler, Jr., C.L.U.
WINSTON-SALEM

Kenneth W. Maust

ARCHIE CARROLL, C.L.U., GENERAL AGENT

NEW ENGLAND

^^V/UUlWy M-i JL JT JCl boston, iussachusetts

fWI COHTANT tMAt roUNMD HUTUM, UTt INIU*A«CI U* *MI*>CA — MM

612 Wachovia Bank Building

Charlotte, N. C.

October, 1960

ADVERTISEMENTS

LIX

.

X

N

lor treatment of

Peptic Ulcers
and Hyperacidity

.

Brand of Hyamagnat

Neutralizes excess acidity
Sustains acid-base balance

Glycamlne Is a New Chemical Compound

— not a mixture of alkalis — that re-establishes nor-
mal digestion without affecting enzymatic activity.
Glycamlne's CONTROLLED ACTION does not
stimulate acid secretion or alkalosis.

NON-SYSTEMIC Glycamine is compatible with
antispasmodics and anticholinergics.

P>ieA&Uae

GLYCAMIiVE TABLETS AM! LIQITD

Available in bottles of 100, 500
and lOOO tablets; or pints.

Lotv dosage

provides prompt

long lasting relief

• Only four pleasant

tasting, chew-up

tablets or four

teaspoonfuls needed

daily. Each dosage

maintains optimum

pH for A-Vi hours.

rand

11EC.

PHARMACEUTICALS

Greensboro, North Carolina

LX

XORTH CAROLINA MEDICAL JOURNAL

October, 1960

Rautrax-N lowers high blood pressure gently,
gradually . . . protects against sharp fluctuations
in the normal pressure swing. Rautrax-N com-
bines Raudixin, the cornerstone of antihyperten-
sive therapy, with Naturetin, the new, saEer
diuretic-antihypertensive agent. The comple-
mentary action of the components permits a
lower dose of each thus reducing the incidence
of side effects. The result: Maximum effective-
ness, minimal dosage, enhanced safety. Rautrax-N
also contains potassium chloride — for added
protection against possible potassium depletion
during maintenance therapy.

Supply: Rautrax-N — capsule-shaped tablets —
50 mg. Raudixin, 4 mg. Naturetin, and 400 mg.
potassium chloride. Rautrax-N Modified —cap-
sule-shaped tablets — 50 mg. Raudixin, 2 mg.
Naturetin, and 400 mg. potassium chloride. For
complete information write Squibb, 745 Fifth
Avenue. New York 22, N. Y.

Stju/bb Qu»Iiry-Tb»

. Rautrax-N

Squibb Standardized Whole Root Rauwolfia Serpentina (Raudixin)

and Beniydroflumethiazide (*Naturetin) with Potassium Chloride SQJ/IBB

STYLES CHANGE

ON COATS:
VITAMINS, TOO

Coat styles change— whether it's a blazer or a B-complex vita-
min. Not long ago, for instance, "Vitamins by Abbott" were
dressed up with a new-style coating— Filmtab®.
The most obvious result was a marked reduction in tablet size-
up to 30% in some products. The tablets themselves were bril-
liant in a variety of rainbow colors. They wouldn't chip or stick
together in the bottle. All vitamin tastes and odors— gone.
Such were the aesthetic gains. Behind these, a significant
pharmaceutical advance: with Filmtab, deterioration is slowed

to an irreducible minimum, because the coating process is

essentially a water-free procedure.

Finally— most important— Filmtab guarantees that the content

of each tablet matches the formula printed on the label. While

the person taking the vitamins may not worry much about rigid

stability, Abbott does. Assures it, through Filmtab.

In short, Filmtab's a name that stands for quality, stability,

potency. The very best in vitamin coatings. Filmtab doesn't add

a penny to the cost. And it's a name found only on

f— | VITAMINS by ABBOTT

NEWEST
NUTRITIONAL
PRODUCT
FROM ABBOTT

d meet special nutritional needs of growing teenagers

Filmtalr

?ICH IN IRON, CALCIUM, VITAMINS-IMPORTANT FACTORS
:0R THE GROWTH YEARS

:ILMTAB-COATED TO CUT SIZE AND ASSURE FULL POTENCY

fANDSOME TABLE BOTTLES AT NO EXTRA COST (100-SIZE)

\LS0 SUPPLIED IN BOTTLES OF 250 AND 1000.

W, DAYTEENS JOINS THE COMPLETE LINE
QUALITY VITAMINS BY ABBOTT:

iLETS®
bottles of 100
is of 50 and 250

,LETS-M®
lecary bottles
) and 250

-potent maintenance
jlas — ideal for the

itionally run-down"

'-SEALED TABS.ET

OPTILETS®

OPTIIETS-M®
Table bottles of
30 and 100
Bottles of 1000

Therapeutic formulas
for more severe de-
ficiencies—illness,
infection, etc.

SUR-BEX®with C
Table bottle of 60
Bottles of 100,
500 and 1000

Therapeutic formula of
the essential B-complex
plus C, for convalescence,
stress, post-surgery, etc.

ABOHATORIES

DAYTEENS

TRADEMARK

EACH DAYTEENS FILMTAB® REPRESENTS

Vitamin A (5000 units) 1.5 mg

Vitamin D (1000 units) 25 meg

Thiamine Mononitrate (Bi) 2 mg

Riboflavin (B2) 2 mg

Nicotinamide 20 mg

Pyridoxine Hydrochloride 0.5 mg

Vitamin B12 (as cobalamin concentrate) 2 meg

Calcium Pantothenate 5 mg

Ascorbic Acid (C) 50 mg

Iron (as sulfate) 10 mg

Copper (as sulfate) 0.15 mg

Iodine (as calcium iodate) 0.1 mg

Manganese (as sulfate) 0.05 mg

Magnesium (as oxide) 0.15 mg

Calcium (as phosphate) 250 mg

Phosphorus (as calcium phosphate) 193 mg

VITAMINS by ABBOTT

October, 1960

ADVERTISEMENTS

LXI

ASHEVILLE

APPALACHIAN HALL

ESTABLISHED — 1916

NORTH CAROLINA

An Institution for the diagnosis and treat ment of Psych atric and Neurological illnesses, rest, convalescence, drug

and alcohol habituation.

Insulin Coma, Electroshock and Psychotherapy are employed. The Institution is equipped with complete laboratory

facilities including electroencephalography and X-ray.

Appalachian Hall is located in Aslieville, North Carolina, a resort town, wnich justly claims an all around climate

for health and comfort. There are ample facilities for classification of patients, rooms single or en suite.

Wm. Ray Griffin, Jr., M.D. Mark A. Griffin, Sr., M.D.

Robert A. Griffin, M.D. Mark A. Griffin, Jr., M.D.

For rates and further information write APPALACHIAN HALL, ASHEVILLE, N. C.

1A

logical
I combination
[ for appetite
| suppression

I meprobamate plus

„• d-amphetamine... suppresses

1

g appetite. ..elevates mood...

H reduces tension... without

E

I insomnia, overstimulation

1 or barbiturate hangover.

anorectic-ataractic

Dosage: One tablet one-half to one hour before each meal.

Patronize

You)

Advertisers

I. XII

NORTH CAROLINA MEDICAL JOURNAL

October, 1960

RY

CHOSEN BY MEDICAL
SOCIETY OF THE STATE OF
NORTH CAROLINA FOR
PROFESSIONAL
LIABILITY INSURANCE

Head Office
412 Addison Building
Charlotte, North Carolina
EDison 2-1633

for your complete insurance needs . . .

| * PROFESSIONAL

* PERSONAL

* PROPERTY

THERE IS A SAINT PAUL AGENT IN YOUR
COMMUNITY AS CLOSE AS YOUR PHONE

HOME OFFICE: 385 WASHINGTON ST., ST. PAUL, MINN.

SERVICE OFFICE: RALEIGH, NORTH CAROLINA— 323 W. MORGAN ST. TEmple 4-7458

BRAWNER'S SANITARIUM, INC.

(Established 1910)
2932 South Atlanta Road, Smyrna, Georgia

FOR THE TREATMENT OF PSYCHIATRIC ILLNESSES
AND PROBLEMS OF ADDICTION

MODERN FAC I LITI ES

Approved by Central Inspection Board of American Psychiatric Association
and the Joint Committee on Accreditation

Jas. N. Brawner, Jr., M.D.
Medical Director

Phone HEmlock 5-4486

October. 1960

ADVERTISEMENTS

LXIII

FOR THERAPY
OF OVERWEIGHT PATIENTS

i d-amphetamine depresses appetite and
elevates mood

i meprobamate eases tensions of dieting
(yet without overstimulation, insomnia or
barbiturate hangover).

Dosage: One tablet one-half to one hour before each meal.

A LOGICAL COMBINATION

IN

APPETITE CONTROL

J

Posture

IS A PLUS

YOU CAN GET FROM SLEEPING ...
THAT'S WHY IT'S WISE TO SLEEP ON A

Sealy

POSTUREPEDIC

Uniformly firm,
Sealy Posturepedic
keeps the spine
level. Healthfully
comfortable, it per-
mits proper relaxa-
tion of musculatory
system and limbs.
Exclusive "live-ac-
tion" coils support
curved, fleshy eon-
tours of the body,
assuring relaxing
rest that you know
is basic to good
health . . . and good
posture.

A Sagging
Mattress Can
Cause This!

PROFESSIONAL

DISCOUNT
OF

$39

00

Limit of one full or
Iwo twin size sets

Please check preference

So that you as a physician can
judge the distinctive features of the
Sealy Posturepedic mattress for
yourself before you recommend it
to your patients, Sealy offers a spe-
cial Doctor's Discount on this mat-
tress and foundation, when pur-
chased for your personal use.

SEALY MATTRESS COMPANY

666 Lake Shore Drive, Chicago 11, Illinois

Posturepedic Mattress

RETAIL

each $79.50

PROFESSIONAL

add state) $60.00

Posturepedic Foundation each $79.50 ,ox | $60.00

1 Full size ( ) 1 Twin size ( ) 2 Twin size ( )
Enclosed is my check and letterhead.

Please send my Sealy Posturepedic Set(s) to:

NAME_

ADDRESS.
TITY

_ZONE_

LXIV

NORTH CAROLINA MEDICAL JOURNAL

October, 1960

SAINT ALBANS

PSYCHIATRIC HOSPITAL

(A Non-Profit Organization)

Radford. Virginia

STAFF

James P. King, M. D., Director
Daniel D. Chiles, M. D. William D. Keck, M. D.

Clinical Director Edward W. Gamble, III, M.

James K. Morrow, M. D. J. William Giesen, M. D.

Silas R. Beatty, M. D. Internist (Consultant)

Clinical Psychology:

Thomas C. Camp, Ph. D.
Artie L. Sturgeon, Ph. D.

Don Phillips
Administrator

AFFILIATED CLINICS

Bluefield Mental Health Center

525 Bland St., Bluefield, W. Va.

David M. Wayne, M. D.

Phone: DAvenport 5-9159

Charleston Mental Health Center

1119 Virginia St., E., Charleston, W. Va.

B. B. Young, M. D.

Phone: Dickens 6-7691

Beckley Mental Health Center

109 E. Main Street, Beckley, W. Va.

W. E. Wilkinson, M. D.

Phone: CLifford 3-8397

Norton Mental Health Clinic

Norton Community Hospital, Norton, Va.

Pierce D. Nelson, M. D.

Phone: 218, Ext. 55 and 56

HIGHLAND HOSPITAL, INC.

Founded In 1904
ASHEVILLE, NORTH CAROLINA

Affiliated with Duke University

A non-profit psychiatric institution, offering modern diagnostic and treatment procedures — insulin, electroshock, psy-
chotherapy, occupational and recreational therapy — for nervous and mental disorders.

The Hospital is located in a 75-acre park, amid the scenic beauties of the Smoky Mountain Range of Western North
Carolina, affording exceptional opportunity for physical and emotional rehabilitation.

The OUT-PATIENT CLINIC offers diagnostic service and therapeutic treatment for selected case desiring non-
resident care.

R. CHARMAN CARROLL, M.D.
Medical Director

ROBERT L. CRAIG, M.D.
Associate Medical Director

JOHN D. PATTON, M.D.
Clinical Director

Joi

October, 1960

ADVERTISEMENTS

LXV

TUCKER HOSPITAL, Inc.

212 West Franklin Street
Richmond. Virginia

A private hospital for diagnosis and treatment of psychiatric and neurol-
ogical patients.
Hospital and out-patient services.

(Organic diseases of the nervous system, psychoneuroses, psychosomatic
disorders, mood disturbances, social adjustment problems, involutional
reactions and selective psychotic and alcoholic problems.)

Dr. James Asa Shield

Dr. Weir M. Tucker

Dr. George S. Fultz

Dr. Amelia G. Wood

Protection Against Loss of Income
from Accident & Sickness as Well as
Hospital Expense Benefits 1'or You ana
All Your Eligible Dependents

All

PREMIUMS

COME FROM

PHYSICIANS
SURGEONS
DENTISTS

All

BENEFITS

60 TO

PHYSICIANS CASUALTY & HEALTH
ASSOCIATIONS

OMAHA 31, NEBRASKA
Since 1902

•Jandsome Professional Appointment Book sent to
you FREE upon request.

A LOGICAL ADJUNCT TO THE
WEIGHT-REDUCING REGIMEN

meprobamate plus d-amphetamine . . .
reduces appetite. ..elevates mood. ..eases
tensions of dieting. ..without overstimula-
tion, insomnia or barbiturate hangover.

Dosage: One tablet one-half to one hour before each meal,
anorectic-ataractic @

I | t ./ "* *

r ~ _^ nJm

* tth m m. m> w m miimW w i *#> %
meprobamate 400 mg., with d-amphetarmne sulfate 5 mg., Tablets

L__

LXVI

NORTH CAROLINA MEDICAL JOURNAL

October, li>60

BETTER GET YOURS

FIRST doctor

/

Money goes fast at Christmas time,
Doctor . . . best you start getting yours now.

And one of the best ways to get your
money before December spending starts, is
to call the Medical-Dental Credit Bureau
nearest you today. They'll clear up your
overdue accounts ... in an ethical, cour-
teous manner . . . and keep your patients
happy, too.

Yes, to beat those December charge
accounts to the draw, call your Medical-
Dental Credit Bureau NOW !

MEDICAL- DENTAL CREDIT BUREAUS

Greensboro — 212 W. Gaston Street — BRoadway 3-8255
High Point — 310 N. Mnin Street — 88 3-1955
Winston-Salem — 514 Nissen Building — PArk 4-8373
Asheville — Westgate Regional Shopping Center — ALpinc 3-7378

Lumberton — 220 East Fitth Street — REdfield 9-3283
Reidsville — 205' 2 W. Morehead Street — Dickens 9-4325
Charlotte — 225 Hawthorne Lane — FRanklin 7-1527
Wilmington — Masonic Temple Building, Room 10 — ROger 3-5191

North Carolina Members — National Association Medical - Dentc.l Bureaus

October, 1960

ADVERTISEMENTS

LXVII

INDEX TO ADVERTISERS

Abbott Laboratories Insert

American Casualty Insurance Company L

American Medical Association V

Ames Company XXX

Appalachian Hall LXI

Brawner's Sanitarium LXII

Bravten Pharmaceutical Company XVII

Bristol Laboratories XII, XVI, XLI

Burroughs-Wellcome & Company XLVIII

Carolina Surgical Supply Co LXVI

Columbus Pharmacal Company LVI

J. L. Crumpton XXXVI

Davies, Rose & Co LIII

Geigy Pharmaceutical LI

Charles C. Haskell and Company XLIII

Highland Hospital LXIV

Hospital Saving Assn. of N. C XXXIII

Jones and Vaughan, Inc Ill

Lederle Laboratories XXXIV, XXXV, XLVI,

LXI, LXIII, LXV, LXVII
Eli Lilly & Company XXXII, Front Cover

May rand, Inc LIX

Medical-Dental Credit Bureau LXVI

Merck, Sharp & Dohme Second Cover, XLIV

Mutual of Omaha LV

New England Mutual Life Insurance Co LVIII

Parke, Davis & Co XX, LXVIII, Third Cover

Physicians Casualty Association

Physicians Health Association LXV

Physicians Products Company IV

Pinebluff Sanitarium I

Pitman-Moore Company LVII

P. Lorillard Company (Kent Cigarettes) XXIII

A. H. Robins Company XIX, XXI

J. B. Roerig & Company XXIV, XXVI,

XXVII, LII

Saint Albans Sanatorium LXIV

Sardeau, Inc XL

W. B. Saunders XIII

Sealv of the Carolinas, Inc LXIII

G. D. Searle & Co XXXVII

Smith-Dorsev Company XVIII, XXIX,

XXXI, XLIX

Smith-Kline & French Laboratories 4th Cover

E. R. Squibbs and Sons XXVIII, XXXVIII,

XLVII, LX
St. Paul Fire and Marine Insurance LXII

The Tilden Company XXXIX

Tucker Hospital LXV

U. S. Vitamin Company Reading

The Upjohn Company XXII, XLII

Wachtel's Incorporated LXVII

Wallace Laboratories VI, VII, XIV, XV, XXV

Wesson Oil and Snowdrift

Sales Company X, XI

Winchester Surgical Supply Co.

Winchester-Ritch Co I

Winthrop Laboratories Insert, IX, XLV, LIV

(Jompl'wie?its of

Wachtel's, Inc

SURGICAL
SUPPLIES

15 Victoria Road

ASHEVILLE, North Carolina

P.O. Box 1716 Telephone AL 3-7616

A

logical

prescription for

overweight patients

anorectic-ataractic

i

I meprobamate 400 mg.. with d-amphetamine sulfate 5 mg., Tablets

[ ■ , \

meprobamate plus d-amphetamine...
depresses appetite... elevates mood...
eases tensions of dieting... without over-
.stimulation, insomnia or barbiturate.-'
hangover. j

l ' Dosage: One tablet one-half to one hour before each meal.

*/

»s*^ *.->

mm

me Businessman nas epilepsy... even ins colleagues

ieed not know- if his seizures are adequately controlled

ILANTIN

ith proper medication, epileptics may achieve success in a wide variety of professions.1
or improved seizure control

® SODIUM KAPSEALS*.-. outstandingly effective in grand'mal and psychomotor seiz-
ures: "Dilantin is an effective anticonvulsant which is useful in controlling
epileptic attacks of any type with the exception of idiopathic petit mal."- "It
[Dilantin] is one of the few useful anticonvulsants in which oversedation is not a common problem when
full therapeutic doses are employed."3 DILANTIN Sodium (diphenylh ydantoin sodium, Parke-Davis) is avail-
able in several forms, including Kapseals of 0.03 Gm. and of 0.1 Gm., in bottles of 100 and 1,000.

other members of THE PARKE-DAVIS FAMILY OF ANTICONVULSANTS

for grand mal and psychomotor seizures: PHELANTIN® Kapseals (Dilantin 100 mg., phenobarbital 30 mg.,
desoxyephedrine hydrochloride 2.5 mg.), bottles of 100. for the petit ?nal triad: MILONTIN® Kapseals (phen-
suximide, Parke-Davis) 0.5 Gm., bottles of 100 and 1,000; Suspension, 250 mg. per 4 oc, 16-ounce bottles
• celontin8 Kapseals (methsuximide, Parke-Davis) 0.3 Gm., bottles of 100.

LITERATURE SUPPLYING DETAILS OF DOSAGE AND ADMINISTRATION AVAILABLE ON REQUEST.
(1) Abraham, W., in Green, .1. R., & Steelman, H. F.: Epileptic Seizures, Baltimore, Williams & Wilkins Company,
1956, p. 132. (2) Crawley, J. W.: M. Clin. North America 42:317 (March) 195S. (S) Bray, P.F.: Pediatrics 23 : 151, 1959.

PARKE- DAVIS

PARKE, DAVIS & COMPANY
Detroit .52, Michigan z7s»<

'J .1

d dieters

■ ■ ■

DEXAMYL Spansule® capsules

Tablets • Elixir

brand of dextro amphetamine and amobarbital

In overweight, 'Dexamyl1 helps your patients
stick to their diets by

1. overcoming the depression which so
often causes overeating

2. relieving the nervousness and irritability so
frequently causedby strict reducing regimens

When listlessness and lethargy are problems in reducing, your patients
will often benefit from the gentle stimulating effect of

DEXEDRINE^1 Spansule' capsules • Tablets • Elixir

brand of dextro amphetamine

Each 'Dexamyl' Spansule sustained release capsule (No. 2) contains 'Dexedrine' (brand of
dextro amphetamine sulfate), 15 mg., and amobarbital, Wz gr. Each 'Dexamyl' Spansule cap-
sule (No. 1) contains 'Dexedrine', 10 mg., and amobarbital, 1 gr.

Each 'Dexedrine' Spansule sustained release capsule contains dextro amphetamine sulfate,
5 mg., 10 mg., or 15 mg.

SMITH
KLINES
FRENCH

NORTH CAROLINA

IN THIS ISSUE:

PANEL DISCUSSION ON DIALYSIS

>r;T?\fKr\

Xtt-

^

when judgment dictates oral penicillin, experience

''30 '60

mqion C F

HEALWTCPfAteS LIBR/

V-CILLIN K

®

(penicillin V potassium, Lilly)

• for maximum effectiveness

• /or unmatched speed

■ /or unsurpassed safety

In tablets of 125 and 250 mg.

ELI LILLY AND COMPANY • INDIANAPOLIS 6, INDIANA, U.S.A.

S&fy

quality/ km* tea/ m

Tabic of Contents, Page II

CLINICAL REMISSION

IN A "PROBLEM" ARTHRITIC

In disabling rheumatoid arthritis. A 62-year-old printer incapacitated
for three years was started on Decadron, 0.75 mg./day. Has lost no
work-time since onset of therapy with Decadron one year ago. Blood
and urine analyses are normal, sedimentation rate dropped from 36
to 7. He is in clinical remission.*

New convenient b, i.d. alternate dosage schedule: the degree and extent of relief provided by
DECADRON allows for b.i.d. maintenance dosage in many patients with so-called "chronic" condi-
tions. Acute manifestations should first be brought under control with a t.i.d. or q.i.d. schedule.

Supplied: As 0.75 mg. and 0.5 mg. scored, pentagon-shaped tablets in bottles of 100. Also available
as Injection DECADRON Phosphate. Additional information on DECADRON is available to physicians
on request. DECADRON is a trademark of Merck & Co., Inc.

From a clinical investigator's report to Merck Sharp & Dolime,

Decadron

Dexamethasone

TREATS MORE PATIENTS MORE EFFECTIVELY

(^3TO MERCK SHARP & D0HME ■ Division of Merck & Co., Inc., West Point, Pa

»utf

November, 1960

ADVERTISEMENTS

A Sanitarium for Rest Under Medical Supervision, and Treatment of Nervous
and Mental Diseases, Alcoholism and Drug Addiction.

The Pinebluff Sanitarium is situated in the sandhills of North Carolina in a 60-acre park
of long pines. It is located on U. S. Route 1, six miles south of Pinehurst and Southern
Pines. This section is unexcelled for its healthful climate.

Ample facilities are afforded for recreational and occupational therapy, particularly out-
of-doors.

Special stress is laid on psychotherapy. An effort is made to help the patient arrive at
an understanding of his problems and by adjustment to his personality difficulties or
modification of personality traits to effect a cure or improvement in the disease. Two resident
physicians and a limited number of patients afford individual treatment in each case.

For further information write:

The Pinebluff Sanitarium, Pinebluff, N. c.

Malcolm D. Kemp, M.D.

Medical Director

HOYER
Patient Lifter

A few light strokes of the hydraulic
pump lifts patient from floor to bed,
toilet, cha'r or car.

EVEREST & JENNINGS

WHEEL CHAIRS & WALKERS

World's finest
Aids for the
Handicapped

Sturdily con-
structed and
easily control-
led, Everest &
Jennings

Folding Wheel Chairs
and Folding Walkers
inspire complete con-
fidence in the user.

Also

Hospital Beds

Safety Bed Sides

Trapeze Patient Helpers

Many Other Sick Room Helps

WINCHESTER

"CAROLINAS' HOUSE OF SERVICE"

Winchester Surgical Supply Co.
119 East 7th Street Charlotte, N. C.

Winchester-Ritch Surgical Co.
42 1 West Smith St. Greensboro, N. C

NORTH CAROLINA MEDICAL JOURNAL

November, 1960

North Carolina Medical Journal

Official Organ of

The Medical Society of the State of North Carolina

Volume 21
Nn. 11

November, 1960

76 CENTS A COPY
$6.00 * VEAR

CONTENT

Original Articles

Symposium on Hemodialysis

Opening- Remarks — Ernest Peschel, M.D. . . 485

The Use of the Artificial Kidney in the
Treatment of Acute Rubular Necrosis —
William B. Blythe, M.D 486

The Use of the Artificial Kidney in Poison-
ings—John H. Felts, M.D 490

Additional Uses of the Ai'tificial Kidney;
Selected Cases of Chronic Renal Failure;
Intractable Edema; Hepatic Coma — Wil-
liam A. Kelemen, M.D 492

Closing- Remarks — Ernest Peschel, M.D. . . 494

Management of Childhood Nephrosis — William
J. A. DeMaria, M.D 495

Remarks by Governor Luther H. Hodges at
the North Carolina Governor's Conference
on Aging 501

The Health and Adjustment of the Aged
Person— Ewald W. Busse, M.D 504

Experiences in a Glaucoma Detection Clinic —
Charles W. Tillett, M.D 509

Special Report

Joint Commission on Accreditation of Hospi-
tals: Analysis, Review and Evaluation of
Clinical Practice in the Hospital — Kenneth
B. Babcock, M.D 510

Report from Duke Poison Control Center . . 511

Editorials

Fall Meeting of the Executive Council . . . 513

Auxiliary Christmas Cards 514

Influenza Immunization Urged 515

Dr. John E. Donley 515

Yale School of Medicine Celebrates Sesquecen-
tennial Anniversary 515

President's Message

Where Does Charity Stop? — Amos N. John-
son, M.D. ..." 51(1

Bulletin Board

Coming Meetings 517

New Members of the State Society 517

News Notes from the Duke University Med-
ical Center 517

News Notes from the University of North
Carolina School of Medicine 518

News Notes from the Bowman Gray School of
Medicine of Wake Forest College .... 519

Watts Hospital Symposium 520

North Carolina Hospitals Board of Control . . 520

Central Carolina Rehabilitation Center . . . 520

County Societies 520

News Notes 520

Announcements 521

The Month in Washington

525

In Memoriam

527

Classified Advertisements

523

Index to Advertisers
lxxv

Entered as second-class matter January 2, 1940, at the Post Office at Winston-Salem. North Carolina, under the Act of
August 24. 1912. Copyright 1960 by the Medical Society of the State of North Carolina.

7jC

®

SYRUP OF CHLORAL HYDRATE

NEW RALDRATE NOW SOLVES THE PROBLEM
OF TASTE RESISTANCE TO CHLORAL-HYDRATE

10 Grains (U.S. P. Dose) of palatable lime flavored
chloral-hydrate syrup in each teaspoonful

RAPID SEDATION WITHOUT HANGOVER
JONES and VAUGHAN, InC. Richmond 26, va.

J lasndl/T

In over five years

Proven

in more than 750 published clinical studies

Effective

for relief of anxiety and tension

Outstandingly Safe

1 simple dosage schedule produces rapid, reliable
tranquilization without unpredictable excitation

2 no cumulative effects, thus no need for difficult
dosage readjustments

.~\ does not produce ataxia, change in appetite or libido

does not produce depression, Parkinson like symptoms,
~^ jaundice or agranulocytosis

^ does not impair mental efficiency or normal behavior

Milt own

meprobamate (Wallace)

Usual dosage: One or two 40(1 mg. tablets t.i.d.
Supplied: 4UU ing. scored tablets. 200 mg. sugar-coated tablets.
Also as meprotabs* — 400 mg. unmarked, coated tablets; and
as meprospan*— 400 mg. and 200 mg. continuous release capsules.

\Y/ WALLACE LABORATORIES / Cranbiny, N. /.

•THAOC-HA1K

k

of clinical use

... for the tense and nervous patient

Despite the introduction in recent years of "new and different" tranquil-
izers, Miltown continues, quietly and steadfastly, to gain in acceptance.
Meprobamate (Miltown) is prescribed by the medical profession more than
any other tranquilizer in the world.

The reasons are not hard to find. Miltown is a known drug. Its few side
effects have been fully reported. There are no surprises in store for either
the patient or the physician.

NEW analgesic

Kills pain

r&»'.

v<

:%«■

m

jS8rw^vv '

r'K

stops tension

For neuralgias, dysmenorrhea, upper respiratory
distress, postsurgical conditions ... new compound
kills pain, stops tension, reduces fever— gives more
complete relief than other analgesics.

Soma Compound is an entirely new, totally dif-
ferent analgesic combination that contains three
drugs. First, Soma: a new type of analgesic that
has proved to be highly effective in relieving
both pain and tension.* Second, phenacetin:
a "standard" analgesic and antipyretic. Third,

caffeine: a safe, mild stimulant for elevation of
mood. As a result, the patient gets more complete
relief than he does with other analgesics.

Soma Compound is nonnarcotic and nonad-
dicting. It reduces pain perception without im-
pairing the natural defense reflexes.*

NEW NONNARCOTIC ANALGESIC

soma® Compound

Composition: Soma (carisoprodol), 200 mg.;
phenacetin, 160 mg.; caffeine, 32 mg.
Dosage: 1 or 2 tablets q.i.d.
Supplied: Bottles of 50 apricot-colored,
scored tablets.

NEW FOR MORE SEVERE PAIN

soma ompound codeine

BOOSTS THE EFFECTIVENESS OF CODEINE: Soma Compound boosts
the effectiveness of codeine. Therefore, only Vi grain of codeine phosphate
is supplied to relieve the more severe pain that usually requires Vz grain.

Composition: Same as Soma Compound plus !4 grain codeine phosphate.

Dosage: 1 or 2 tablets q.i.d.

Supplied: Bottles of 50 white, lozenge-shaped tablets; subject to Federal Narcotics Regulations.

'References available on request.

W WALLACE LABORATORIES • Cranbury, N. J.

Trancoprin

A Tablets

a broad spectrum
non-narcotic analgesic

Trancoprin, a new analgesic, not only raises the pain perception threshold
but, through its chlormezanone component, also relaxes skeletal muscle spasm1'6
and quiets the psyche.2,357

The effectiveness of Trancoprin has been demonstrated clinically8 in a
number of patients with a wide variety of painful disorders ranging from
headache, dysmenorrhea and lumbago to arthritis and sciatica. In a series of
862 patients,8 Trancoprin brought excellent or good relief of pain to 88 per cent
of the group. In another series,9 Trancoprin was administered in an industrial
dispensary to 61 patients with headache, bursitis, neuritis or arthritis. The
excellent results obtained prompted the prediction that Trancoprin ". . . will
prove a valuable and safe drug for the industrial physician."9

Exceptionally Safe

No serious side effects have been encountered with Trancoprin. Of 923
patients treated with Trancoprin, only 22 (2.4 per cent) experienced any side
effects.89 In every instance, these reactions, which included temporary gastric
distress, weakness or sedation, were mild and easily reversed.

Indications

Trancoprin is recommended for more comprehensive control of the pain
complex (pain -»» tension— > spasm) in those disorders in which tension and
spasm are complicating factors, such as: headaches, including tension head-
aches / premenstrual tension and dysmenorrhea / low back pain, sciatica,
lumbago / musculoskeletal pain associated with strains or sprains, myositis,
fibrositis, bursitis, trauma, disc syndrome and myalgia / arthritis (rheumatoid
or hypertrophic) / torticollis / neuralgia.

Dosage

The usual adult dosage is 2 Trancoprin tablets three or four times daily.
The dosage for children from 5 to 12 years of age is 1 tablet three or four times
daily. Trancoprin is so well tolerated that it may be taken on an empty stomach
for quickest effect. The relief of symptoms is apparent in from fifteen to thirty
minutes after administration and may last up to six hours or longer.

How Supplied

Each Trancoprin tablet contains 300 mg. (5 grains) of acetylsalicylic acid
and 50 mg. of chlormezanone [Tran copal" brand]. Bottles of 100 and 1000.

1 ranCOprill Tablets / non-narcotic analgesic

References: 1. DeNyse. D. L.: M. Times 87: 1512. Nov., 1959. 2. Ganz. S. E.: J. Indiana M. A. 52:1134. July, 1959.
3. Gruenberg, Friedrich: Current Therap. Res. 2:1, Jan., 1960. 4. Kearney, R. D.: Current Therap. Res. 2:127, April.
1960. 5. Lichtman, A. L.: Kentucky Acad. Gen. Pract. J 4:28, Oct., 1958. 6. Mullin, W. G., and Epifano, Leonard: Am.
Pract. & Digest Treat. 10:1743, Oct., 1959. 7. Shanaphy, J. F.: Current Therap. Res. 1:59. Oct., 1959. 8. Collective
Study, Department of Medical Research, Winthrop Laboratories. 9. Hergesheimer, L. H.: An evaluation of a muscle
relaxant (Trancopal) alone and with aspirin (Trancoprin) in an industrial medical practice, to be submitted.

LABORATORIES , New York 18, N. Y.

VIII NORTH CAROLINA MEDICAL JOURNAL November, 1960

Medical Society of the State of North Carolina

OFFICERS — 1960

President — Amos Neill Johnson, M.D., Garland

President Elect — Claude B. Squires, M.D., 225 Hawthorne Lane, Charlotte
Past President — John C. Reece, M.D., Grace Hospital, Morganton
First Vice-President — Theodore S. Raiford, M.D., Doctors Building, Asheville
Second Vice-President — Charles T. Wilkinson, M.D., Wake Forest
Secretary — John S. Rhodes, M.D., 700 West Morgan Street, Raleigh
Executive Director — Mr. James T. Barnes, 203 Capital Club Building, Raleigh
The President, Secretary and Executive Director are members ex-officio

of all committees
Speaker-House of Delegates — Donald B. Koonce, M.D., 408 N. 11th St., Wilmington
Vice-Speaker-House of Delegates — E. W. Schoenheit, M.D., 46 Haywood St., Asheville

COUNCILORS — 1958 - 1961

First District— T. P. Brinn, M.D., 118 W. Market Street, Hertford

Vice Councilor — Q. E. Cooke, M.D., Murfreesboro
Second District — Lynwood E. Williams, M.D., Kinston Clinic, Kinston

Vice Councilor — Ernest W. Larkin, Jr., M.D., 211 N. Market St., Washington
Third District — Dewey H. Bridger, M.D., Bladenboro

Vice Councilor — William A. Greene, M.D., 104 E. Commerce St., Whiteville
Fourth District — Edgar T. Beddingfield, Jr., M.D., P.O. Box 137, Stantonsburg

Vice Councilor — Donnie H. Jones, M.D., Box 67, Princeton
Fifth District— Ralph B. Garrison, M.D., 222 N. Main Street, Hamlet

Vice Councilor — Harold A. Peck, M.D., Moore County Hospital, Pinehurst
Sixth District — George W. Paschal, Jr., M.D., 1110 Wake Forest Rd., Raleigh

Vice Councilor— Rives W. Taylor, M.D., P.O. Box 1191, Oxford
Seventh District —

Vice Councilor — Edward S. Bivens, M.D., Stanly County Hospital, Albemarle
Eighth District — Merle D. Bonner, M.D., 1023 N. Elm Street, Greensboro

Vice Councilor — Harry L. Johnson, M.D., P.O. Box 530, Elkin
Ninth District — Thomas Lynch Murphy, M.D., 116 Rutherford St., Salisbury

Vice Councilor — Paul McNeely Deaton, M.D., 766 Hartness St., Statesville
Tenth District — William A. Sams, M.D., Main Street, Marshall

Vice Councilor— W. Otis Duck, M.D., Drawer 517, Mars Hill

DELEGATES TO THE AMERICAN MEDICAL ASSOCIATION

Elias S. Faison, M.D., 1012 Kings Drive, Charlotte

C. F. Strosnider, M.D., 111 E. Chestnut Street, Goldsboro

Millard D. Hill, M.D., 15 W. Hargett Street, Raleigh

William F. Hollister, M.D., (Alternate), Pinehurst Surgical Clinic, Pinehurst

Joseph F. McGowan, M.D., (Alternate), 29 Market Street, Asheville

Wm. McN. Nicholson, M.D., (Alternate), Duke Hospital, Durham

SECTION CHAIRMEN 1959-1960

General Practice of Medicine — Julius Sader, M.D., 205 East Main Street, Brevard
Internal Medicine — Walter Spaeth, M.D., 116 South Road, Elizabeth City
Ophthalmology and Otolaryngology — Charles W. Tillett, Jr., M.D., 1511 Scott

Avenue, Charlotte
Surgery — James E. Davis, M.D., 1200 Broad Street, Durham
Pediatrics — William W. Farley, M.D., 903 West Peace Street, Raleigh
Obstetrics & Gynecology — H. Fleming Fuller, M.D., Kinston Clinic, Kinston
Public Health and Education — Isa C. Grant, M.D., Box 949, Raleigh
Neurology & Psychiatry — Myron G. Sandifer, M.D., N. C. Memorial Hospital,

Chapel Hill
Radiology — Isadore Meschan, M.D., Bowman Gray School of Medicine,

Winston-Salem
Pathology — Roger W. Morrison, M.D., 65 Sunset Parkway, Asheville
Anesthesia — Charles E. Whitcher, M.D., Route 1, Pfafftown
Orthopedics & Traumatology — Chalmers R. Carr, M.D., 1822 Brunswick Avenue,

Charlotte
Student AMA Chapters — Mr. John Feagin, Duke University School of Medicine,

Durham

November, 1960

ADVERTISEMENTS

IX

Ml

Uth CLINICAL MEETING

November 28, 29, 30
December 1

Washington,

D.C.

it and Informative Cross-Section

For, ALL Physicians

c^r-j^i

United States Capitol

E -

White House

Uur nation's historic capital city will
be the setting for the American Medical
Association's 14th Clinical Meeting
November 28 through December 1.

The program — planned to interest
and inform every physician — features
the latest medical developments pre-
sented in panel discussions, sympo-
siums, round table sessions, lectures,
closed circuit telecasts and motion pic-
tures. Many scientific and industrial
exhibits will be on display.

Mount Vernon

Smithsonian Institution

AMERICAN MEDICAL ASSOCIATION

535 North Dearborn Street, Chicago 10, Illinois

now-for
more comprehensive

control of

INDICATIONS

Head: temporomandibular
muscle spasm • Neck: acute
torticollis, osteoarthritis of cer-
vical spine with spasm of cervical
muscles, whiplash injury • Trunk and Chest: costochondritis, intercostal myositis, xiphodynia • Back:
acute and chronic lumbar strains and sprains, acute low back pain (unspecified), acute lumbar arthritis
and traumatic injury, compression fracture, herniated intervertebral disc, post-disc syndrome, strained
muscle(s) • Extremities: acute hip injury with muscle spasm, ankle sprain, arthritis (as of foot or knee),
blow to shin followed by muscle spasm, bursitis, spasm or strain of muscle or muscle group, old fracture
with recurrent spasm, Pellegrini-Stieda disease, tenosynovitis with associated pain and spasm.

-pain due to

or

-spasm of skeletal muscle

a new muscle relaxant-analgesic

3

al

ROBAXIN® WITH ASPIRIN

Many conditions, painful in themselves, often give rise to spasm of skeletal muscles.
ROBAXISAL, the new dual-acting muscle relaxant-analgesic, treats both the pain and
the spasm with marked success: In clinical studies on 311 patients, 12 investigators1
reported satisfactory results in 86.5%. Each ROBAXISAL Tablet contains:

• A relaxant component — Robaxin* — widely recognized for its prompt, long-lasting relief of
painful skeletal muscle spasm, with unusual freedom from undesired side effects 400 mg.

•Methocarbamol Robins. U.S. Pat. No. 2770649.

• An analgesic component — aspirin — whose pain-relieving effect is markedly enhanced by Robaxin,
and which has added value as an anti-inflammatory and anti-rheumatic agent. ... (5 gr.) 325 mg.

SUPPLY: Robaxisal Tablets (pink-and-
white, laminated) in bottles of 100 and 500.

Also available: Robaxin Injectable, 1.0 Gm.
in 10-cc. ampul. Robaxin Tablets, 0.S Gm.
(white, scored) in bottles of 50 and 500.

...or luhen anxiety accompanies pain and spasm : ROBAXISAL*-PH
(Robaxin® with Phenaphen®). Sedative-enhanced analgesic and skeletal
muscle relaxant. Each two white-and-green laminated Robaxisai.-PH tab-
lets contain: methocarbamol 800 mg., plus the equivalent of one Phenaphen
capsule (phenacetin 194 mg., acetylsalicylic acid 162 mg., hyoscyamine sul-
fate 0.031 mg., and 54 gr. phenobarbital 16.2 mg.). Bottles of 100 and 500.

'Clinical reports in files of A. H. Robins Co., Inc., from: J. Allen. Madison, Wise.. B. Billow. New York, N. Y . B. Decker. Richmond, Vs..
C Freeman. Jr.. Augusta. Ga.. R. B. Gordon, New York, N. Y., J. E. Holmblad. Schenectady. N. Y., L. Levy, New York. N. Y.. N. LoBue.
i Heights. III., H. Nachman, Richmond, W, A. Poindexter, Los Angeles, Cat., E. Rogers, Brooklyn, N. Y., K. H. Strong, Fairfield, la.

itional information available upon request.

Making today's medicines with integrity . . . seeking tomorrow's with persistence

What's she doing that's of medical interest?

's drinking a glass of pure Florida
nge juice. And that's important to
physician for several reasons.
-low your patients obtain their vita-
is or any of the other nutrients found
:itrus fruits is of great medical inter-
— considering the fact there are so
iy wrong ways of doing it, so many
stitutes and imitations for the real

Actually, there's no better way for
; young lady to obtain her vitamin C
n by doing just what she is doing,

for there's no better source than oranges
and grapefruit ripened in the Florida
sunshine. There's no substitute for the
result of nature's own mysterious chem-
istry, flourishing in the warmth of this
luxurious peninsula.

An obvious truth, you might say, but
not so obvious to the parents of many
teen-agers.

We know that a tall glass of orange
juice is just about the best thing they
can reach for when they raid the refrig-
erator. We also know that if you en-

courage this refreshing and healthful
habit among your young patients — and
for that matter, your patients of any age
— you'll be helping them to the finest
between-meals drink there is.

Nothing has ever matched the quality
of Florida citrus — watched over as it
is by a State Commission that enforces
the world's highest standards for quality
in fresh, frozen, canned or cartoned
citrus fruits and juices.

That's why the young lady's activities
are of medical interest.

® Florida Citrus Commission, Lakeland, Florida

©

E CLOMYCIN

DEMETHYLCHLORTETRACYCLINE LEDERLE

attains

sustains

retains

■

antibiotic
activity

extra-activity... promptly attained

DECLOMYCIN Demethylchlortetracycline attains
—usually within two hours-blood levels more than
adequate to suppress susceptible pathogens.
These levels are attained in tissues and body fluids
on daily dosages substantially lower than those
required to elicit antibiotic activity of comparable
intensity with other tetracyclines. With other tetra-
cyclines, the average, effective, adult daily dose is
1 Gm. With DECLOMYCIN Demethylchlortetracy-
cline, it is only 600 mg.

IV

ECL

lins,

r

led

licat

ni
iil-v
Iwa

TETRACYCLINE

ACTIVITY

WITH

DECLOMYCIN

THERAPY

DOSAGE
150 mg. q.i.d.

TETRACYCLINE

ACTIVITY

WITH OTHER

TETRACYCLINE

THERAPY

DOSAGE
250 mg. q.i.d.

POSITIVE ANTIBACTERIAL ACTION

ECLOI

evenly sustained

ECLOMYCIN Demethylchlortetracycline sus-
lins, through the entire therapeutic course, the
jigh activity levels needed to control the primary
lifective process and to check the onset of a com-
licating secondary infection at the original— or at
lother— site. This combined therapeutic action
i sustained, in most instances, without the
ronounced hour-to-hour, dose-to-dose, peak-
nd-valley fluctuations in activity levels which
haracterize other tetracyclines.

long retained

DECLOMYCIN Demethylchlortetracycline retains
significant activity levels, up to 48 hours after
the last dose is given. At least a full, extra day
of positive antibacterial action may thus be con-
fidently expected. One capsule four times a day,
for the average adult in the average infection, is
the same as with other tetracyclines — but the
total dosage is lower and the duration of anti-
infective action is longer.

DAYS 12 3 4 5 6

A^AA ▲

DAYS OF TETRACYCLINE A' DOSAGE 1

DURATION OF PROTECTION jjSSQ
DAYS OF TETRACYCLINE B' DOSAGE Ry Jj3$

OTHER TETRACYCLINES-PEAKS AND VALLEYS

DURATION OF PROTECTION ftp J

DAYS OF TETRACYCLINE C DOSAGE

DURATION OF PROTECTION

DAYS OF DECLOMYCIN DOSAGE

DURATION OF PROTECTION

ROTECTION AGAINST PROBLEM PATHOGENS

(1) Oxytetracycline. (2) Chlortetracycline. (3) Tetracycline.

PROTECTION AGAINST RECURRENCE

MYCIN

DEMETHYLCHLORTETRACYCLINE LEDERLE

■ higher activity/intake ratio— positive antibacterial action

■ sustained activity levels- protection against problem pathogens

■ up to two extra days' activity- protection against recurrence

CAPSULES, 150 mg., bottles of 16 and 100. Dosage: Average infections- 1
capsule four times daily. Severe infections- Initial dose of 2 capsules, then 1
capsule every six hours.

PEDIATRIC DROPS, 60mg./cc. in 10 cc. bottle with calibrated, plastic dropper.
Dosage: 1 to 2 drops (3 to 6 mg.) per pound body weight per day-divided into 4 doses.
SYRUP, 75 mg. 5 cc. teaspoonful (cherry-flavored), bottles of 2 and 16 fl. oz.
Dosage: 3 to 6 mg. per pound body weight per day — divided into 4 doses.

for the

added measure
of protection
in clinical
practice

PRECAUTIONS: As with other antibiotics, DECLOMYCIN may occasionally give rise to glossitis,
stomatitis, proctitis, nausea, diarrhea, vaginitis or dermatitis. A photodynamic reaction to sun-
light has been observed in a few patients on DECLOMYCIN. Although reversible by discontinuing
therapy, patients should avoid exposure to intense sunlight. If adverse reaction or idiosyncrasy
occurs, discontinue medication.

Overgrowth of nonsusceptible organisms is a possibility with DECLOMYCIN, as with other
antibiotics. The patient should be kept under observation.

E CLOMYCIN

DEMETHYLCHLORTETRACYCLINE LEDERLE

LED E RLE LABORATORIES, a Division of AMERICAN CYAN AM ID COMPANY, Pearl River, New York

FIORINAL

relieves pain,
muscle spas tn,
nervous tension

rapid action • non-narcotic • economical

"We have found caffeine, used in combination with acetylsalicylic acid, acetophenetidin,

and isobutylallylbarbituric acid, [Fiorina]] to be one of the most

effective medicaments for the symptomatic treatment of headache due to tension."

Friedman, A. P., and Merritt, H. H.: J. A.M. A. 763:1111 (Mar. 30) 1957.

Lvai.lublc: Fiorinal Tablets and
lew Form — Fiorinal Capsules

Each contains: Sandopta] f Allylbarbituric Acid N.F. X)

50 mg. (3/4 gr. ) . caffeine 40 mg. (2/3 gr.), acetylsalicylic acid

200 ing. (3 gr. I. acetophenetidin 130 mg. (2gr. ).

/>,.«

1

«,1

Tif-T CI :1V

* Sfiaft^jte***

£* *~ ~ ***** «?J['

^^^r * If

i

qj % ■>

VY\

v

Alveolar exudate

in bacterial pneumonia

Therapeutic
confidence

Panalba is effective against
more than 30 commonly
encountered pathogens
including staphylococci
resistant to other antibiotics.
Right from the start,
prescribing it gives you a
high degree of assurance
of obtaining the desired
anti-infective action in this
as in a wide variety of
bacterial diseases.

Supplied: Capsules, each
containing Panmycin*
Phosphate (tetracycline
phosphate complex ) ,
equivalent to 250 mg.
tetracycline hydrochloride,
and 125 mg. Albamycin,*
as novobiocin sodium, in
bottles of 16 and 100.

'Trademark. Reg. U. S. Pat. Off.

Panalba

your broad-spectrum
antibiotic of first resort

for relief from the total cold syndrome

safe cou

classic

expectora

action

superior upper
ispiratory
econgestion

Tus sage sic

timed-release tablets/suspension

Each tsp. (5 ml.) of Tussagesic Suspension
provides:

TRIAMINICB' 2.'. me.

DORMETHAN (brand of dextromethorphan HKr) . . 15 IHg.

TERPIN HYDRATE 90 mg.

APAP (acetaminophen* 1 — *' nig.

Tussagesic Suspension is especially suited
for children and for adults who prefer liquid
medication ; it is pleasantly flavored, non-
narcotic and non-alcoholic.

Dosage (to be taken every 3 or 4 hours):
Adults and children over 12—1 or 2 tsp.;
Children (I to 12- 1 tsp.; Children 1 to 6 —
• traoeh.bk % tsP-! Children under 1 — % tsp.

SMITH-DORSE Y • a division of The Wander Company • Lincoln, Nebraska

Each Tussagesic timed-release Tablet
provides:

TRIAMIN1CS 50 mg.

DORMETHAN (brand of deitromethorphnn HHr) . . 30 (TIE-

TERPIN HYDRATE ISO mg.

APAP (acetaminophen) 325 mg.

Dosage: Adults and children over 12 — one
tablet in the morning, midafternoon and at
bedtime. Each tablet should be swallowed
whole to preserve the timed-release action.

UNSURPASSED "GENERAL-PURPOSE" CORTICOSTEROID.

Arist

Triamcinolone LEDERLE

OUTSTANDING FOR "SPECIAL-PURPOSE" THERAPY

for "specii
whencorti<

-

surpassed "general-purpose" steroid . . . outst

Triamcinolone has long since proved its
unsurpassed efficacy and relative safety in the therapy of rheumatoid arthritis,
inflammatory and allergic dermatoses, bronchial asthma, and all other condi-
tions in which corticosteroids are indicated. But ARISTOCORT has also opened up
new areas of therapy for selected patients who otherwise could not be given corti-
costeroids. Medicine is now in an era of "special-purpose" steroids.1

One outstanding advantage of triam-
cinolone is that it rarely produces
edema and sodium retention.1-2

The clinical importance of this prop-
erty cannot be overemphasized in
treating certain types of patients.
McGavack and associates3 have
reported the beneficial results with
ARISTOCORT in patients with existing
or impending cardiac failure, and those
with obesity associated with lymph-
edema. Triamcinolone, in contrast to
most other steroids, is not contraindi-
cated in the presence of edema or
impending cardiac decompensation.3

Hollander1 points out the superiority
of triamcinolone in not causing mental
stimulation, increased appetite and
weight gain, compared to other steroids
which produce these effects in varying

degrees. And McGavack,2 in a compar-
ative tabulation of steroid side effects,
indicates that triamcinolone does not
produce the increased appetite, insom-
nia, and psychic disturbances associ-
ated with other newer steroids.

ARISTOCORT can thus be advantageous
for patients requiring corticosteroids
whose appetites should not be stimu-
lated, and for those who are already
overweight or should not gain weight.
Likewise, ARISTOCORT is suitable for
the many patients with emotional and
nervous disorders who should not be
subjected to psychic stimulation. Fur-
thermore, ARISTOCORT Triamcinolone,
in effective doses, showed a low inci-
dence of side reactions and is a steroid
of choice for treating the older patient
in whom salt and water retention may
cause serious damage.2

References: 1. Hollander, J. L.: J. A.M. A. 172:306 (Jan. 23) 1960. 2. McGavack,
T. H.: NebraskaM.J. 44:377 (Aug.) 1959. 3. McGavack, T. H.; Kao.K.Y.T.;
Leake, D. A.; Bauer, H. G., and Berger, H. E.: Am. J. M. Sc. 236:720 (Dec.)
1958.

Precautions: Collateral hormonal effects generally associated with cortico-
steroids may be induced. These include Cushingoid manifestations and muscle
weakness. However, sodium and potassium retention, edema, weight gain,
psychic aberration and hypertension are exceedingly rare. Dosage should be
individualized and kept at the lowest level needed to control symptoms. It
should not exceed 36 mg. daily without potassium supplementation. Drug
should not be withdrawn abruptly. Contraindicated in herpes simplex and
chicken pox.

Supplied: Scored tablets — 1 mg. (yellow); 2 mg. (pink); 4 mg. (white);
16 mg. ( white) .

(edarle

LEDERLE LABORATORIES. A Division of AMERICAN CYANAMID COMPANY. Pearl River. New York

Simple Diet Changes i

can help control serum cholesterol J

r

■*-**

/

w<

L-.l:r

■

■Ha

•

B^^Bi

Fortunately for the patient's morale — often all
that is necessary when you want to prescribe a
regimen to reduce serum cholesterol is to . . .

1. control the amount of calories and the type of
dietary f at . . . and

2. make a simple modification in the method of
food preparation, using poly-unsaturated
vegetable oil in place of saturated fats

Obviously, in any special diet, the fewer required
changes in the patient's eating habits, the more
likelihood there is that the patient will adhere to
the prescribed diet.

After adjusting total fat and calorie intake, the
pie replacement of saturated fats (those used at
table and in cooking) with poty-unsaturated We
makes possible a most subtle dietary change,
conforms completely to therapeutic requireme
Uniformity you can depend on. Wesson ha
poly-unsaturated content better than 50%. Only
lightest cottonseed oils of high iodine nur
are selected for Wesson and no significant vi
tions in standards are permitted in the 22 exac
specifications required before bottling.
Wesson satisfies the most exacting appet
To be effective, a diet must be eaten by the pat

W*Z*l

' -f ifKULT

* -

T —

Wesson is
poly-unsaturated . . .
never hydrogenated

for Frying

■F»3W

*si** >-^ if I » W ■

L

. majority of housewives prefer Wesson particu-
iy by the criteria of odor, flavor (blandness) and
itness of color. (Substantiated by sales leadership
59 years and reconfirmed by recent tests against
next leading brand with brand identification
loved, among a national probability sample.)

ly-unsaturated Wesson is unsurpassed
any readily available brand, where a
getable (salad) oil is medically
commended for a cholesterol depres-
nt regimen.

WESSON'S IMPORTANT CONSTITUENTS

Wesson is 100% cottonseed oil . . . winterized and of selected quality

Linoleic acid glycerides (poly-unsaturated) 50-55%

Oleic acid glycerides (mono-unsaturated) 16-20%

Total unsaturated 70-75%

Palmitic, stearic and myristic glycerides (saturated) .... 25-30%

Phytosterol (Predominantly beta sitosterol) 0.3-0.5%

Total tocopherols 0-09"0-12^

Never hydrogenated-completely salt free

Free Wesson recipes for delicious main dishes, desserts and salad dressings
are available for your patients. Request quantity needed from The Wesson
People, Dept. N, 210 Baronne St., New Orleans 12, La.

w^o coughed?

WHENEVER COUGH THERAPY
IS INDICATED

HYCOMINE

THE COMPLETE Rx

Syrup

FOR COUGH CONTROL

cough sedative / antihistamine
decongestant / expectorant

relieves cough and associated symptoms in 15-20
minutes ■ effective for 6 hours or longer ■ pro-
motes expectoration ■ rarely constipates ■ agree-
ably cherry-flavored

Each teaspoonful (5 cc.) of Hycomine* Syrup contains:
Hycodan®

Dihydrocodeinone Bitartrate 5mg.">

(Warning: May be habit-forming) > 6.5 mg.

Homatropine Methylbromide 1.5 mg.J

Pyrilamine Maleate 12.5 mg.

Phenylephrine Hydrochloride 10 m g.

Ammonium Chloride 60 mg.

Sodium Citrate 85 mg.

Average adult dose: One teaspoonful after meals and at bedtime.
May be habit-forming. Federal law permits oral prescription.

~~ Literature on request

ENDO LABORATORIES

Richmond Hill 18, New York

•U.S. Pat. 2,630.400

or

mo
Die

eff,

E

Dos

Sun. Mon. Tue. Wed. Thur.

Fri. Sat

■■■■■■■

Dosage: 2 Tablets B.I.D. (A.M. & P.M.)

in premenstrual tension

only
treats the wfole syndrome

It was the introduction of neo Bromth several years ago that created such widespread
interest in the premenstrual syndrome — because of neo Bromth's specific ability
to prevent the development of the condition in the first place.

The action of neo Bromth is not limited merely to control of abnormal water retention,
or of nervousness, or of pain — or any other single or several of the multiple
manifestations characteristic of premenstrual tension, neo Bromth effectively controls
the whole syndrome.

neo Bromth is also 'completely free from the undesirable side effects associated with
such limited-action therapy as ammonium chloride, hormones, tranquilizers and potent
diuretics, neo Bromth has continued to prove to be the safest — as well as the most
effective — treatment for premenstrual tension.

Each 80 mg. tablet contains 50 mg. Pamabrom, and 30 mg. pyrilamine maleate.
Dosage is 2 tablets twice daily (morning and night) beginning 5 to 7 days before
menstruation. Discontinue when the flow starts.

DDAVTCU DU A DM A P CIITIP A I PflMDAMV . P hattanrmoa Q TonnPCCPP

m

benzthmzide

NaClex

a new molecule
with an
unsurpassed
faculty for
salt excretion

A. II. Robins announces NaClex, a potent, oral, non-
mercurial diuretic. NaClex is a new molecule, desig-
nated benzthiazide. Its unique chemical structure
produces a "pronounced increase in diuretic potency"1
over many older diuretics. NaClex also has antihy-
pertensive properties, and it enhances the activity of
other antihypertensive drugs.

in

diuresis

salt removal
is still the
fundamental
objective

As salt goes, so goes edema

A fundamental principle of diuresis is that "increased
urine volume and loss of body weight are proportional
to and the osmotic consequences of loss of ions."2 New
NaClex helps reduce edema through the application
of this basic principle.

Apparently functioning in the proximal renal tubules,
NaClex strictly limits the reabsorption of sodium and
chloride ions. To maintain the essential, subtle balance
between salt and water, the body's homeostatic mech-
anism reponds to this loss of ions by allowing an
increased excretion of excessive extracellular water.
Thus the NaClex-induced removal of salt leads
directly to the reduction of edema.

How potent is benzlhiazide?

Compared tablet for tablet with oral diuretics now
available, NaClex is unsurpassed in potency. Milli-
gram for milligram, it has achieved optimum diuresis
in pharmacologic studies at 1/20 the dose required
for chlorothiazide.

II 'hat are the major diuretic indications for NaClex?
NaClex produces diuresis, weight loss, and sympto-
matic improvement in edema associated with condi-
tions such as congestive heart failure, cirrhosis of the
liver, chronic renal diseases (including nephrosis),
premenstrual tension, toxemia of pregnancy, and
obesity. Edema of local origin and that caused by
steroids may also benefit.

To what extent is NaClex useful in hypertension?
NaClex has definite antihypertensive properties, and
may be used alone in mild hypertension. In severer
cases it may be used with other antihypertensive

drugs, potentiating them and permitting their use at
lower dosage. In hypertension with associated water
retention, NaClex is of twofold value. It may be
prescribed for congestive heart failure as an ancillary
measure to digitalis.

Is potassium excretion a problem with NaClex?
In short-term therapy, excessive potassium excretion
is unlikely. In the effective dose range, potassium loss
varies from Vo to V2 that of sodium. Naturally, the
ratio of these ions depends on the rate at which
excess sodium stores are depleted, and whether salt
intake is restricted.

Can NaClex and mercurials be given concurrently?
Yes. When so employed, NaClex may increase the
efficacy of mercurials. But NaClex alone is often
effective enough to eliminate the need for parenteral
mercurial administration. Also, NaClex may be effec-
tive in cases when mercurials are not.

Supply: Available in yellow, scored 50 mg. tablets.

References: 1. Ford, R. V., Cur. Therap. Res., 2:51,
1960. 2. Pitts, R. F., Am. J. Med., 24:745, 1958.

For complete dosage schedules, precautions, or other informa-
tion about new NaClex, please consult basic literature,
package insert, or jour local Robins representative, or write
to A. H. Robins Co., Inc., Richmond, Va.

A. H. ROBINS COMPANY, INC.
RICHMOND 20, VIRGINIA ,

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XXXVI

NORTH CAROLINA MEDICAL JOURNAL

November, 1900

an antibiotic improvement

designed to provide

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/

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-m-u Pulvules

llosone

(propionyl erythromycin eslcr lauryl sulfate. Lilly)

in a more acid-stable form

assure adequate absorption even ivhen taken with food

llosone retains 97.3 percent of its antibacterial activity after exposure to gastric
juice (pH 1.1) for forty minutes.1 This means there is more antibiotic available
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Supplied in 125 and 250-mg. Pulvules and in suspension and drops.

1. Stephens, V. C, etal.:J. Am. Pharm. A. (Scient. Ed.). 48:620, 1959.

2. Salitsky, S., et a/.: Antibiotics Annual, p. 893, 1959-1960.

3. Reichelderfer, T. E„ etal.: Antibiotics Annual, p. 899, 1959-1S

4. Kuder, H. V.: Clin. Pharmacol. & Therap., in press.

1960.

ELI LILLY AND COMPANY • INDIANAPOLIS 6, INDIANA, U.S.A.

North Carolina Medical Journal

Owned and Published by
The Medical Society of the State of North Carolina

Volume 21

November, 1960

No. 11

Panel Discussion on Dialysis

Opening Remarks

Ernst Peschel, M.D.
Durham

The initial paragraph of the first publica-
tion on an artificial kidney, written in 1913
by Abel, Rountree, and Turner from Johns
Hopkins, describes very well the purpose of
such an instrument. The title of the paper
is "On the Removal of Diffusible Substances
From the Circulating Blood by Means of
Dialysis", and the first paragraph reads
like this :

There are numerous toxic states in which the
eliminating organs of the body, more especially
the kidneys, are incapable of removing from the
body, at an adequate rate, the natural or un-
natural substances whose accumulation is detri-
mental to life. In the hope of providing a sub-
stitute in such emergencies, which might tide
over a dangerous crisis, as well as for the im-
portant information which it might be expected
to provide, concerning the substances normally
present in the blood, and also for the light that
might thus be thrown on intermediary stages of
metabolism, a method has been devised by which
the blood of a living animal may be submitted
to dialysis outside the body, and again returned
to the natural circulation without exposure to
air, infection by microorganisms, or any altera-
tion which would necessarily be prejudicial to
life. This process may be appropriately referred
to as "vivi-diffusion."

All types of artificial kidneys are based on
this principle of vivi-diffusion, as they called
it, or extracorporeal hemodialysis, as we
call it now: the substitution of an artificial
semi-permeable membrane for the non-func-
tioning or insufficiently functioning kidney.

As an introduction to our discussion, I
would like to make a few comments on the
history of the artificial kidney, and on the
indications for its use in general. Other
members of the panel will then talk about
more specific aspects of the treatment.

Presented before the Section Internal Medicine, Medical So-
ciety of the State of North Carolina, Raleigh, May 10, 1960.

The first utilization of the principle of
dialysis, by Abel, Rountree, and Turner 47
years ago, was in experimental animals.
Attempts to apply it in human beings failed
at that time, mainly for two reasons : No
material satisfactorily suitable as a semi-
permeable membrane was available, and no
effective and sufficiently non-toxic antico-
agulant existed. Both these problems were
solved during the years of the last war when
cellophane and heparin became available.

In 1943 a Dutch physician, Willem Kolff,
described the first artificial kidney that was
practicable in human beings. He had con-
structed it with rather primitive means and
used it successfully in a few patients. It
consisted of a drum around which a cello-
phane tube was wound. While the drum ro-
tated, the blood was promoted by gravity
and the patient's ai'terial pressure. The bath
fluid into which the tubes were immersed
contained the essential electrolytes in nor-
mal concentrations or modified according to
the need for removing, or adding any indi-
vidual blood component. Dialyzation took
place while the tubes were dipping into the
fluid.

The first lot of this model was ready in
September, 1944. Dr. Kolff's facilities in
Holland for further developing the instru-
ment were limited, and he came to this
country in 1951, joining the Cleveland Clinic,
where he still is.

In the meantime, in 1947, artificial kid-
neys of somewhat different construction had
been designed in Sweden and in Canada.
The Swedish model is used in some clinics
in Europe. It works with a stationary cello-
phane tube around which the dialyzing fluid
is moved.

Another type, again considerably differ-
ent, was described in 1948 by Skeggs and

186

NORTH CAROLINA .MEDICAL JOURNAL

November, 1960

Leonard of Cleveland. This type is used in
a number of places in this country, mainly
in the west.

Kolff, in cooperation with a group in Bos-
ton, had perfected his original instrument
just when the Korean war started. A so-
called renal insufficiency center was set up
around such an instrument in Korea to
which wounded soldiers were flown by heli-
copter from the front hospitals. In a rela-
tively short time the great value of this in-
strument was definitely established. Since
then, its use has been gradually increasing.

This is quite an expensive, complicated
instrument. Its fundamental construction is
similar to Kolff's first type, but it has many
additional features, mainly concerned with
treating the blood more gently on its way
outside the body.

Kolff tried to simplify it and at the same
time to include the feature of ultrafiltration,
which was not possible with the original
model. Ultrafiltration is desirable because
most oliguric or anuric patients are over-
hydrated from the unsuccessful attempt to
force the production of urine by giving
fluids. Unless the oliguria is prerenal in
origin, this measure does not work, and in-
creases the danger to the patient.

This latest type of artificial kidney has
been commercially available for the past
three years. We have found its technical
performance to be very good. The actual
kidney consists of cellophane tubing en-
cased in a fiberglass screen and wound in
form of a coil. The whole dialyzing unit
can be held in one hand. The apparatus is
not only simpler in construction than former
models, but it also obviates the cumbersome
and time-consuming procedures of special
sterilization, autoclaving, and so forth. The
dialyzing unit, with all the parts which
come in direct contact with the blood, is dis-
posable ; it is used only once. The units are
supplied in sterile condition, immediately
ready for use.

As to the general indications for dialysis,
one might list three or perhaps four groups :
(1) acute renal failure in a patient with
previously healthy kidneys, due either to
nephrotoxins or to acute tubular necrosis
from ischemia, formerly called lower ne-
phron nephrosis; (2) poisoning other than
nephrotoxins — situations where the kidney
itself is not necessarily damaged; (3) un-
der certain circumstances, selected cases of
chronic renal disease; (4) miscellaneous sit-
uations such as intractable edema or hepatic
coma.

The Use of the Artificial Kidney in the
Treatment of Acute Tubular Necrosis

William B. Blythe.
Chapel Hill

M.D.

Experience with artificial kidneys in treat-
ing acute tubular necrosis has increased re-
markably in the past 10 years. Although
hemodialysis was being utilized in the treat-
ment of this disease in several large centers
in this country prior to then, enthusiasm for
its use was limited and sporadic.

At least two factors have served as im-
petus for this mushrooming experience.
First, during the oKrean War it was amply
demonstrated, after the development of a
renal center in which thorough medical
management could be achieved, that the use

*From the Department of Medicine. University of North
Carolina School of Medicine. Chapel Hill.

Fellow, Life Insurance Medical Research Fund.

of the artificial kidney strikingly reduced
the mortality rate from 80 to 50 per cent
in posttraumatic acute tubular necrosis'1'.
Second, the development of a more portable,
more easily operated, and less expensive
instrument, as typified by the Kolff twin-coil
kidney-1, has made the apparatus more
widely available.

The ensuing accumulated experience has
resulted in more or less genei'al agreement
that hemodialysis is a necessary concomitant
to the conservative management of acute
tubular necrosis. There seems to be little
doubt that hemodialysis has been life-saving
in certain instances where other measures
failed, and, further, there is a growing body
of evidence that hemodialysis decreases the

November, 1960

PANEL DISCUSSION ON DIALYSIS

487

morbidity and incidence of complications in
acute tubular necrosis.

It should be pointed out, however, that
whether or not hemodialysis materially af-
fects the mortality rate in acute tubular
necrosis (other than in those cases associ-
ated with severe trauma) remains unestab-
lished. At a recent conference in which in-
formation from many areas was combined'11,
the over-all mortality rate was found to be
43 per cent, a figure which has been achieved
before in civilian practice by conservative
management alone.

It is highly unlikely that this question of
mortality will be answered within the near
future. Nevertheless, this doubt does not
detract from the efficacy of the artificial
kidney in selected problems in acute tubular
necrosis, but should serve only to restrain
us from overlooking important clu°s in the
pathogenesis and thorough medical manage-
ment of the disease.

As experience with the artificial kidney
has broadened, indications for its use have
changed. At present they range from those
which are clearcut and agreed upon to those
which are vague and in dispute.

Chemical Imbalances

Hyperkalemia

The most notable and unchanging indica-
tion for hemodialysis is uncontrollable hy-
perkalemia. Hemodialysis is unsurpassed in
the rapidity and certainty with which the
extracellular concentration of potassium
may be reduced. At the North Carolina
Memorial Hospital, however, the incidence
of uncontrollable hyperkalemia has been
impressively reduced by the aggressive use
of cation exchange resins. Uncontrollable
hyperkalemia, therefore, in our experience,
is not a common indication for dialysis.
There are times, however, when patients
are admitted to the hospital with dangerous
extracellular concentrations of potassium,
and the more conservative measures are not
satisfactory in achieving normal serum po-
tassium concentration. The following case
is illustrative.

Case 1
A 16 year old Negro boy with a history of five
days of anuria (see table 1) had come to the Emer-
gency Room because of "kidney colic" two weeks
before admission. Then it had been learned that he
had undergone a right nephrectomy several years
previously because of renal stones. On the night of
admission physical examination revealed a lethargic

Table 1

Early Hospital Course of a Patient with Anuria
of Five Days' Duration

1 IMS

SERUM <K)^

CLINICAL STATUS

TREATMENT

11:00 P.M.

9.7

0BTUN0ED, WEAK,

50 7. GLUCOSE WITH

AREFLEXIC, ECG =

INSULIN Ca v*

IDIOVENTRICULAR

GLUCONATE,

RHYTHM

RESIN ENEMAS

12 3n A.M.

8.8

STRONGER, ACTIVE

SAME AS ABOVE.

REFLEXES. ECG =

UNSUCCESSFUL ATTEMPT

NORMAL RHYTHM AND

AT URETERAL

SIGNS OF HYPERKA-

CATHETERIZATION

LEMIA

2:00 A.M.

8.7

ALERT, MUCH
STRONGER. ECG =
NORMAL RHYTHM AND
PEAKED T WAVES

SAME AS ABOVE

4:00 A.M.

8.7

SAME

SAME

7:30 A.M.

6.5

ALERT

DIALYSIS STARTED

10:30 A.M.

1.8

ALERT, NORMAL ECG

DIALYSIS ENDED

URETEROLITHOTOMY

PERFORMED

8:30 P.M.

1.2

LARGE DIURESIS

toy who demonstrated marked weakness and are-
fiexia, and the electrocardiogram showed idioven-
tric lar rhythm, all suggestive of hyperkalemia.
The sen m potassium was 9.7 mEq. per liter. Ad-
ministration of a solution containing 50 per cent
glucose with insulin and calcium gluconate was
begun. A flat film of the abdomen revealed a cal-
culus just superior to the left ureterovesical junc-
tion. An attempt to pass a ureteral catheter be-
yond the calculus was unsuccessful.

It was decided that a urethrolithotomy should
be performed as soon as the serum potassium could
be lowered to a safe level. After several hours of
administration of glucose and insulin and calcium
gluconate intravenously and sodium exchange res-
ins by rectum, the serum potassium remained at
8.7 mEq. per liter. It was then decided that the
artificial kidney should be used. Hemodialysis was
undertaken for three hours, at which point the se-
rum potassium was 4.8 mEq. per liter. It should be
mentioned that a serum potassium determination
obtained at the time dialysis was started was 6.5
mEq. per liter. Following dialysis, a ureterolith-
otomy was performed and a stone found to consist
of pure cystine was removed. The patient began
voiding freely, had an unremarkable postoperative
course, and has continued to do well.

The case demonstrates several principles.
First of all, the measures that were initially
used to lower serum potassium — that is, ad-
ministration of glucose and insulin intraven-
ously and cation exchange resins rectally —
can be quite effective in combating hyper-
kalemia. Secondly, these measures cannot
always be depended upon to lower serum
potassium to safe levels and to keep the con-
centration low. In these instances the arti-
ficial kidney is almost always effective. It
should be pointed out that the case just cited
was encountered early in our experience
with the artificial kidney. Were a similar
situation to arise at our hospital now, we
would doubtless institute dialysis much
earlier.

488

NORTH CAROLINA MEDICAL JOURNAL

November, 19(i0

Others

Other chemical derangements such as ex-
treme elevations in blood urea nitrogen and
marked acidosis in themselves are often con-
sidered in some centers as indications for
dialysis. Because extracellular fluid is ef-
fectively removed by machines employing
ultrafiltration — such as the Kolff twin-coil
kidney — marked overhydration, when re-
sulting in symptoms of water intoxication
or cardiac failure, may be an indication for
hemodialysis. Dialysis may be extremely
useful, since the main avenue for the dis-
posal of excess fluid, the urine output, is
absent.

Clinical Deterioration
It has become increasingly apparent to
those treating acute tubular necrosis that
lowering the serum potassium to normal, as
well as correcting acidosis and other electro-
lyte derangements, does not uniformly pre-
vent clinical deterioration as manifested by
mental obtunclity, twitching, convulsions,
and coma. Furthermore, there is not always
clear correlation between the appearance of

these symptoms and the concentration of
blood urea nitrogen, in itself not thought to
be toxic, but rather an indication of the
retention of other substances which are
toxic. For these reasons, clinical deteriora-
tion of the patient rather than chemical ab-
normalities per se has become a major indi-
cation for hemodialysis.

At the present time the ease of decision
to dialyze is directly dependent upon the
rigidity of criteria used to make the de-
cision. At the North Carolina Memorial
Hospital clinical deterioration has been the
most frequent reason for dialysis in acute
tubular necrosis.

I should like to illustrate how this cri-
terion is applied by presenting two cases
which are similar in several respects (fig.
1). The patients were both of approximate-
ly the same age, the etiology of the tubular
necrosis was associated with pregnancy in
both cases, and both patients appeared
acutely ill upon admission to the hospital.
In one case it was felt necessary to institute
hemodialysis and in the other it was with-

E S - 26yr old N F,
NC.MH" B7463

12 13 14 15 16 17 16 19 20 21 22 23 24 25 26 27 28 29 30 31

DAYS IN HOSPITAL

Fig. 1. Hospital course of two patients with acute
tubular necrosis. (Dialysis was undertaken in pa-
tient represented in lower part of figure because of
clinical deterioration.)

November, 1960

PANEL DISCUSSION ON DIALYSIS

489

held. Both patients recovered and at present
are doing well.

Case 2

Five days prior to admission a 26 year old
Negro woman, gravida ix, para vii, had been ad-
mitted to another hospital because of continuous
convulsions associated with toxemia of pregnancy.
There a caesarean section had been performed. Dur-
ing the succeeding five days the urinary output de-
creased progressively from 450 cc. on the first post-
operative day to 50 cc. on the day of admission
to our hospital. She was transferred to the North
Carolina Memorial Hospital because of the oliguria.

Physical examination revealed an agitated Negro
woman who appeared critically ill. Pertinent find-
ings were slight cardiomegaly and other signs of
mild congestive heart failure, a soft abdomen with
bowel sounds, a clean-looking abdominal wound,
and 2 plus sacral edema.

Chemical data were: serum sodium 109 mEq. per
liter, serum potassium 6.5 mEq. per liter, serum
and carbon dioxide 11.7 mEq. per liter. A chest
film revealed an enlarged heart and questionable
pulmonary congestion. Electrocardiogram showed
moderate peaking of the T waves, but no other
evidence of hyperkalemia.

At this juncture it was felt that the diagnosis of
acute renal failure was firmly established. The
eitology was not clear, although the history of
toxemia with convulsions plus the caesarean sec-
tion were thought to be a likely background for
hypotension and subsequent acute tubular necrosis.

It was decided that no clear cut indications for
dialysis were present, but that it should be insti-
tuted in the event of further clinical deterioration.
The patient was digitalized and a program of so-
dium ion exchange resin by rectum was begun. Hy-
pertonic glucose was given in order to minimize
protein breakdown and afford proper water replace-
ment.

During the ensuing 24 hours the serum potassium
was lowered to 5.5 mEq. per liter, and the patient
became slightly more alert. Thereafter the serum
potassium remained within normal limits, the car-
bon dioxide returned to normal, and the patient be-
came even more alert and felt stronger. Manage-
ment consisted of proper replacement of water, sup-
ply of carbohydrate, and continued resin enemas.
Diuresis began on the third hospital day and was
adequate by the seventh day. Dialysis was with-
held from this patient, since there was no mental
deterioration and the chemical environment was
satisfactorily controlled.

Case 3

A 29 year old Negro woman, gravida v, para iv,
was admitted to another hospital four days prior
to admission to the North Carolina Memorial Hos-
pital. She gave a history of having missed one
menstrual period. On the day of admission there
she had experienced severe generalized abdominal
pain and marked vaginal bleeding. She was febrile

and hypotensive, and pelvic examination revealed
placental tissue in the cervical os. No history of
self-induced abortion could be obtained. The bleed-
ing was controlled by Pitocin. The following day,
during a blood transfusion, she became febrile, ap-
prehensive, and complained of chilly sensations. Dur-
ing the ensuing four days urinary output was al-
ways less than 300 cc. per day.

Because of this situation she was transferred to
the North Carolina Memorial Hospital. Examination
on admission disclosed an acutely ill-appearing,
well oriented Negro woman. The temperature was
98 °F., pulse 90, respiration 20, and blood pressure
130 systolic, 80 diastolic. The heart was not en-
larged, and there was no evidence of congestive
heart failure. The abdomen was distended and ten-
der, and there were no bowel sounds. There was
1 plus pretibial edema and no sacral edema. Expert
opinion was that a dilatation and curettage was
not indicated and that peritonitis was not present.

Chemical data were: serum sodium 126 mEq. per
liter, serum potassium 5.5 mEq. per liter and se-
rum carbon dioxide 13 mEq. per liter. A chest film
was negative and an electrocardiogram showed no
signs of hyperkalemia.

The patient was treated for four days with proper
fluid replacement, calories adequate to minimize
protein breakdown, and cation exchange resins.
During this time hyperkalemia and acidosis were
not a problem. She became more lethargic, and on
the night of the fourth day she had a convulsion
and became much less responsive.

Because of these developments, a six-hour di-
alysis was performed on the following day. Al-
though she did not become more alert, the twitch-
ing, which had been prominent, disappeared. Since
the next few days following dialysis brought little
change, the measure was not repeated.

Diuresis began on the twelfth day and gradually
became more marked. The patient became more
alert and active, and fully recovered.

Although it cannot be proved that dialysis
was life-saving in this case, it seems prob-
able that it might have been since the pa-
tient showed evidence of deterioration early
in the course of anuria.

Prophylaxis

Although there have been recent reports
which propose repeated prophylactic dial-
yses as a means to prevent clinical deteri-
oration'4', this is not practical in most insti-
tutions at present. Since the over-all mortal-
ity rate in acute tubular necrosis is about
50 per cent without it, dialysis of all patients
in order to lower mortality would result in
many unnecessary dialyses. Therefore, the
efficacy of prophylactic dialysis should be
clearly established before it is undertaken on
a widespread scale.

490

NORTH CAROLINA MEDICAL JOURNAL

November, lllliO

Summary

The value of hemodialysis as a therapeu-
tic adjunct in the management of acute tu-
bular necrosis has been firmly established,
although the fundamental question of wheth-
er mortality rate will be lowered by its use
remains unanswered. Indications for dial-
ysis range from those which are undisputed
to those which are not agreed upon. Uncon-
trollable hyperkalemia continues to be the
clearest indication for dialysis. At pres-
ent clinical deterioration, rather than chem-
ical abnormalities per se (other than hyper-
kalemia), seems to be a more reliable cri-
terion. Whether prophylactic dialysis is the
best means of managing acute tubular ne-
crosis remains to be established.

References

1. Smith. L. H.. Jr., and others: Post-traumatic Renal In-
sufficiency in Military Casualties. II. Management, Use of

an Artificial Kidney, Prognosis, in Battle Casualties in
Korea: Studies of the Surgical Research Team, Vol. IV.
Post-traumatic Renal Insufficiency, Army Medical Service
Graduate School, Walter Reed Army Medical Center. Wash-
ington, D. C, Government Printing Office, 1955-56.

KoltT. W. J., and Watschinger, B.: Further Development
of Coil Kidney: Disposable Artificial Kidney. J. Lab. &
Clin. Med. 47:969-977 (June! 1956.

Proceedings, Study Group on Acute Renal Failure, held at
U. S. Army Surgical Research Unit. Brooke Army Medical
Center, October 14-16, 1957. unpublished data, cited by
Bluemle. L. W., Jr., Webster. G. D., Jr.. and Elkinton,
J. R.: Acute Tubular Necrosis: Analysis of 1011 Cases with
Respect to Mortality. Complications, and Treatment with
and without Dialysis. A.M. A. Arch. Med. 104:18(1-197,
(Aug.) 1959.

(a) Teschan, P. E.. O'Brien, T. F.. and Baxter, C. R.:
Prophylactic Daily Hemodialysis in Treatment of Acute
Renal Failure. Clin. Research 7:280 (April) 1959. (b)
Scribner. B. H.. Buri, R., and Caner, J. E. Z.; Continuous
Hemodialysis as a Method of Preventing Uremia in Acute
Renal Failure, Program of the Fifty-Second Annual Meet-
ing of the American Society for Clinical Investigation.
May. 1960.

The Use of the Artificial Kidney in Poisonings

John H. Felts, M.D.*
Winston-Salem

Naturally an artificial kidney was first
used to treat patients with renal disease.
It then was a short step to use hemodialysis
to help normal kidneys rid the body of exo-
genous toxins before irreparable damage had
been produced. The latter application is lim-
ited only by the biochemical behavior of the
poison. The molecule must be small enough
to pass through the membrane, and this flow
across the membrane should be rapid enough
to clear the blood of a large proportion of
the ingested dose within a short time. The
rate at which the toxin is removed will be
determined by the rapidity and degree of
plasma protein and tissue binding, the rate
of its metabolic degradation, the volume of
tissue distribution, and the route of excre-
tion of the agent or its degradation products.
These factors, too, determine the prognosis,
particularly if a long period has elapsed
since the poison was taken or if a tremen-
dously large dose was used.

Because most dialyzable poisons (table 1)
produce coma, the initial problem is usually
the management of coma. Recent evidence"'

•From the Department of Internal Medicine. Bowman Gray
School of Medicine of Wake Forest College and the Medical
Service. North Carolina Baptist Hospital. Winston-Salem,
North Carolina.

Supported by the John A. Hartford Foundation.

suggests that conservative management with
minimum medication results in the lowest
morbidity and mortality. This requires sim-
ply the maintenance of adequate blood pres-
sure, urine flow and respiratory gas ex-
change, together with scrupulous clinical
observation so that the earliest signs of de-
terioration may be detected. This is the
stage in which hemodialysis is probably in-
dicated unless the toxic agent is one which
may produce irreparable damage. Then hem-
odialysis on identification seems preferable.

This procedure is not a substitute for ra-
tional management, and if a conservative
program is followed it will not be necessary
in most cases. We routinely have our coma
patients seen in consultation and followed
by an anesthesiologist, who is responsible for
the maintenance of respiratory exchange.

Table 1
Dialyzable Agents
Phenobarbital
Butabarbital
Amobarbital
Pentobarbital
Secobarbital
Bromide
Salicylate

Glutethimide (Doriden)
Ethinyl-cyclohexyl carbamate (Valmid)
Ethylene glycol
Streptomycin

November, I960

PANEL DISCUSSION ON DIALYSIS

491

When necessary, an indwelling endotracheal
tube is used. Hydration and urine flow are
maintained by appropriate parenteral fluids
with a catheter indwelling to permit careful
measurement of flow. We determine blood
pH, carbon dioxide, sodium and potassium
and end-expiratory carbon dioxide as indi-
cated. A portable chest film and an electro-
cardiogram are taken as soon as possible.
If clinical or radiographic evidence of pneu-
monia is present, an appropriate bactericidal
antibiotic is used. We do not "cover" the
indwelling catheter with an antibiotic, be-
cause the catheter will be removed shortly
and we will not be able to prevent the en-
trance of micro-organisms with any of the
antimicrobial agents currently employed : if
bacteriuria persists after recovery, appro-
priate therapy is instituted. Nor do we em-
Hoy analeptic agents, which have been use-
less in our experience.

Barbiturates

Members of the barbiturate family are
still the most popular drugs for suicide at-
tempts, and fortunately most of these are
dialyzable'2'. Phenobarbital is probably the
most effectively removed, with butabarbital,
amobarbital and pentobarbital following in
this order. Secobarbital is metabolized so
rapidly that it is poorly dialyzable. Our last
four instances of barbiturate poisoning were
produced by butabarbital ; none of these
required dialysis. Despite their entrenched
position, barbiturates are giving some
ground to the newer synthetic hypnotics
among the distraught and suicidal. Fortu-
nately two of these hypnotics are dialyzable-
glutethimide (Doriden)1" and ethinyl-cyclo-
hexyl carbamate (Valmid)14'. We have had
no serious intoxication with any agents
other than glutethimide and have had no
deaths in patients who have been indiscreet
in using this latter preparation.

If an artificial kidney had been available
two or three decades ago in North Carolina,
we would probably have found greater use
for it in the treatment of bromide poisonings
because bromide intoxication can be treated
most effectively in this manner151. This agent
was once a Carolina favorite and as recently
as 1951 Hodges and Gilmour"" reported 36
cases of bromide intoxication observed in a
three year period.

Salicylate poisoning is a problem of in-
creasing importance in our expanding pop-
ulation, because children may ingest large

quantities accidentally. Salicylate poisoning
is a mixed disturbance, producing both res-
piratory alkalosis and metabolic acidosis17',
and is difficult to treat because of its com-
plexity. Fortunately salicylate is dialyzable
and hemodialysis has proved quite effective
in lowering morbidity and mortality when
employed soon enough"".

Another agent frequently ingested acci-
dentally in the belief or hope that it may be
a substitute for ethyl alcohol is ethylene gly-
col. This is a major constituent of automo-
bile antifreeze and when ingested may pro-
duce severe central nervous system, cardiac,
and renal damage. Prompt hemodialysis in
such a situation may prevent irreversible
changes in the central nervous system as
well as the precipitation of oxalate crystals
in the kidney which might be expected to
produce a severe permanent nephropathy191.

Finally some attention might be directed
to an iatrogenic condition in which hemo-
dialysis can be of therapeutic value. Strep-
tomycin is excreted by the kidney, so that
in chronic renal disease decreased excretion
may lead to prolonged retention with great-
er danger of damaging the eighth nerve. For
this reason it has been recommended that
the use of streptomycin be carefully limited
in patients wth chronic renal disease. It is
dialyzable, however, and hemodialysis has
been used successfully for the alleviation
of ototoxicity'1"1.

Summary

The artificial kidney properly employed
is a useful means of treating certain cases
of poisoning. It is not a substitute for but
rather a logical addition to proper medical
management.

References

1. (a) Nilsson. E.: On Treatment of Barbiturate Poisoning;
Modified Clinical Aspect. Acta med. scandiav, (supp. 253)
139:1-127, 1951. (b) Eekenhoff. J. E.. and Dam. W.: The
Treatment of Barbiturate Poisoning with and without An-
aleptics. Am. J. Med. 20:912-918 (June) 1956. (c) Hayes,
D. M.: Current Concepts of Barbiturate Intoxication, North
Carolina M. J. 10:105-112 (March) 1958.

2. (a) Kyle. L. H., and others: The Application of Hemo-
dialysis to the Treatment of Barbiturate Poisoning. J. Clin.
Invest. 32:364-671 (April) 1953. (b) Honey, G. E.. and
Jackson, R. C: Artificial Respiration and an Artificial
Kidney for Severe Barbiturate Poisoning, Brit. M. J.
2:1134-1137 (Nov. 28) 1959.

3. Schreiner, G. E-. and others: Acute Glutethimide (Doriden)
Poisoning, A.M. A. Arch. Int. Me 1. 101:899-911 (May) 195S.

4. Davis. R. P.. Blythe. W. B„ Newton, M., and Welt, L. G.:
The Treatment of Intoxication with Ethynyl-cyclohexyl
Carbamate (Valmid) by Extracorporeal Hemodialysis: A
Case Report. Yale J. Biol. & Med. 32:192, 1960.

5. Merrill, J. p., and Weller, J. M.: Treatment of Bromism
with the Artificial Kidney, Ann. Int. Med. 37:186-190
(July) 1952.

492

NORTH CAROLINA MEDICAL JOURNAL

November, 19(50

Hodges, H. H., and Gilmour, M. T. : The Continuing Haz-
ards of Bromide Intoxication, Am. J. Med. 10:459-462
I April I 1951.

la) Singer, R. B.: The Acid-Base Disturbance in Salicy-
late Intoxication, Medicine 33:1-13 I Feb. I 1954. (b) Ten-
ney, S. M., and Miller, R. M.: The Respiratory and Circu-
latory Actions of Salicylates. Am. J. Med. 19:498-508
(Oct.) 1955.
Schreiner, G. E., Herman, L. B., Griffin, J., and Feys, J.:

Specific Therapy for Salieylism, New England J. Med.
253:213-217 (Aug. 11) 1955.
9. Schreiner, G. E-, J. F. Maher, J. Marc-Aurele, D. Know-
Ian and M. Alvo: Ethylene glycol: two medications for
hemodialysis, Tr. Am. Soc. Art. Int. Organs 6:81-85, 1959.
10. Edwards, K. D. G. and Whyte, H. M.: Streptomycin Poi-
soning in Renal Failure: An Indication for Treatment with
an Artificial Kidney. Brit. M. J. 1:752-754 (March 21)
1959.

Additional Uses of the Artificial Kidney :

Selected Cases of Chronic Renal Failures
Intractable Edema; Hepatic Coma

William A. Kelemen, M.D.
Charlotte

In the treatment of chronic and irrevers-
ible diseases, the two basic features of the
twin-coil artificial kidney"1, dialysis and fil-
tration, may be employed as palliative meas-
ures. Other standard therapeutic methods
have inherent limitations (failure to remove
nitrogenous products and fixed acids). One
need not, and should not, separate the em-
ployment of the artificial kidney from other
forms of therapy, since life may be pro-
longed for greater periods than may be felt
to be compatible in chronic diseases. The
question often arises as to whether this
practice is justified.

Chronic Renal Failure

The criteria for treatment of chronic renal
failure lie primarily in the symptoms and
signs rather than in specific abnormalities
of the blood constituents. As the total func-
tioning nephron units diminish, progressive
derangements of the uremic syndrome be-
come evident. While deterioration will in-
crease in certain patients regardless of
measures used, the hope is that the artificial
kidney will reverse the trend and potenti-
ate other forms of treatment. The follow-
ing factors, therefore, will be considered in
selecting patients for dialysis :

1. Blood pressure: The degree and dura-
tion of hypertension, if present, and whether
it is benign or malignant should be consid-
ered. It has been shown that renal function
decreases progressively as the blood pres-
sure increases2', and that it may improve
with antihypertensive therapy resulting in
lowered mortality'3'. Though the blood pres-
sure may be controlled in patients having
malignant hypertension, parenchymal and
perivascular hyperplasia with varying de-

grees of renal parenchymal atrophy will de-
velop, leading to progressive renal failure.
When malignant hypertension is attended
by renal failure, dialysis is not indicated.
In severe benign hypertension, the prognosis
is not favorable, but the over-all evaluation
and response to antihypertensive drug s
should be considered.

2. Renal size: If x-ray studies (a flat
film of the abdomen, retrograde pyelograms,
or both) show the kidneys to be significant-
ly contracted, this loss of renal mass car-
ries a grave prognosis. In addition, renal
arteriograms will reveal a reduced vascula-
ture, manifested as "silver wire" effects,
rather than the normal diffuse fine glomular
outline in the cortex.

3. Associated diseases: While uremia
alone places a heavy burden on the patient,
other debilitating disease, such as caricino-
matosis, may nullify any benefit derived
from dialysis ; yet dialysis can play an im-
portant supportive role in preparing a seri-
ously ill patient — for example, one with ob-
structing renal calculus — for surgery when
otherwise only palliative measures might be
undertaken.

4. Histologic findings of renal biopsy:
Whether needle or open biopsies are done,
examination of adequate specimens will be
of diagnostic and prognostic value' '. The
histologic findings will strongly influence
therapy.

5. Volume of urine: The volume of urine
is of utmost importance. In the absence of
dehydration, a fixed small volume (less than
1000 cc. per 24 hours) represents a serious
further depression of glomerular filtration
and a decrease of functioning nephrons due

November, 1960

PANEL DISCUSSION ON DIALYSIS

493

to glomerular and parenchymal disease'6'.
Prognosis is poor when this compensatory
mechanism fails to meet even these minimal
excretory needs. A serious drawback in the
use of the artificial kidney is that urinary
suppression can be produced during the pro-
cedure. This oliguria and or anuria may
last for several days, nullifying the benefi-
cial effects of dialysis.

6. Degree of elevation of serum creati-
nine and serum phosphorus: When the se-
rum creatinine approaches 12 mg. per 100
ml., approximately 95 per cent of the glo-
meruli are non - functioning'7'. Similarly,
when phosphorus retention occurs, glomeru-
lar filtration is reduced to 20 per cent of
normal volume"". Dialysis should not be
done when both of these substances are
markedly elevated.

In general, patients who have severe glo-
merular disease (subacute and chronic glo-
merulonephritis, lupus erythematosus, poly-
arteritis nodosa, scleroderma, amyloidosis,
diabetic glomerulosclerosis, malignant ne-
phrosclerosis) will respond poorly to dialy-
sis, while those having parenchymal dis-
eases, pyelonephritis, and polycystic renal
disease may fare better.

Intractable Edema

Patients who have excessive fluid reten-
tion, whether due to cardiac failure, espe-
cially when attended by renal failure, or
to renal disease primarily, may be benefited
by dehydration'"'.

Congestive heart failure need not be a
contraindication to dialysis, though care
must be taken to avoid potassium removal
with resultant digitalis intoxication. Should
the patient be refractory to diuretics or fail
to respond rapidly and sufficiently enough
to prevent death from pulmonary edema,
then dialysis may be employed. Following
dialysis the patients may once more be-
come sensitive to diuretics.

Dialysis may prevent cardiopulmonary
complications from developing in patients
having the nephrotic syndrome due to mem-
branous glomerulopathy resulting in oligu-
ria. Time will be gained for a trial of steroid
therapy.

Since 6 to 12 pounds of fluid may be re-
moved during a course of treatment with
the artificial kidney, care must be taken to
avoid hypotension and vascular collapse. A
slower rate of removal of edema fluid or
multiple dialyses may be necessary to al-

low time between treatments for compart-
mental adjustments.

Hepatic Coma

The prognosis of hepatic coma is grave,
since it represents further hepatic insuffi-
ciency and failure of detoxification of am-
monia. Medical management'11" is directed
toward either preventing the formation of
excessive ammonia or utilizing ammonia al-
ready present. Dialysis will aid in the re-
moval of ammonia should the response to
medical management be insufficient, though
it is probably not indicated in instances of
improper diet or ingestion of ammonium
drugs'11'. However, prognosis has been
shown to be poor when the serum bilirubin
concentration is greater than 20 mg. per
100 ml. and the sodium concentration less
than 130 mEq. per liter in the presence of
ascites or gastrointestinal bleeding1 10a,0).

The development of renal insufficiency is
also ominous1121. While dialysis is not indi-
cated in severe hepatic cell necrosis (acute
yellow atrophy) it would seem to have some-
thing to offer in instances where renal fail-
ure has also developed, here to maintain the
patient at a critical time while awaiting
response to liver therapy. Dialysis may be
of value in coma following hemorrhage from
esophageal and gastric varices. The risk of
further bleeding during dialysis can be les-
sened by the use of regional hepariniza-
tion'1:!l.

Summary
Admittedly, the over-all outlook for pa-
tients having chronic irreversible disease is
poor. The use of the artificial kidney offers
additional benefit through the removal of
nitrogenous wastes, fixed acids, and edema,
while correcting electrolyte disturbances.
The selection of patients with chronic renal
failure for dialysis is based on evidence of
potential renal function. Consideration of
blood pressure, renal size, histologic find-
ings, urine volume, serum creatinine, serum
phosphorus, and associated diseases helps to
determine whether the artificial kidney
should be employed. In intractable edema
of cardiac or renal origin, filtration relieves
danger to the cardiopulmonary system and
allows time for other therapy. Ammonia is
dialyzable and offers a means of supple-
mental therapy in hepatic coma, especially
when renal failure occurs. Even with di-
alysis, however, the prognosis at this stage
of liver disease remains poor.

494

NORTH CAROLINA MEDICAL JOURNAL

November, I960

References

In) Kolff. W. J., and Watschinger. li.: Further Develop-
ment of a Coil Kidney: Disposable Artificial Kidney. Lad.
& Clin. Med. 47: !IB9-;*77 Uutie) 1956. (b) Meyer. R., and
others: Laboratory and Clinical Evaluation of the Kolff-
Coil Kidney, J. Lab. & Clin. Med. 51:715-723 (May) 1958.
Mover. J. H.. Heider, C. Pevey, k\. and Ford, R. V.:
Vascular Status of a Heterogeneous Group of Patients
with Hypertension, with Particular Emphasis on Renal
Function, Am. J. Me.l. 24:164-176 (Feb.) 1958.
Mover. J. H., Heider, C. Pevey. K. and Ford. R. V.: The
ElTect of Treatment of the Vascular Deterioration Asso-
ciated with Hypertension, with Particular Emphasis on
Renal Function. Am. J. Mel. 24: 177-192 (Feb.) 1958.
McCormack. L. J.. Belaud. J. E.. Schneckloth. R. E.. and
Corcoran. A. C: Effects of Antihypertensive Treatment
on the Evaluation of Renal Lesions in Malignant Nephro-
sclerosis. Am. J. Path. 34:1011-1021 (Nov.-Dec.) 1958.
(a) Schreiner. G. E., and Berman, L. B.: Experience with
150 Consecutive Renal Biopsies, South. M. J. 50:733-738
(June) 1957. (b) Brun. C. and Raaschou, F.: Kidney-
Biopsies. Am. J. Med. 24:676-691 (May) 1958.
Franklin. S. S. and Merrill. .1. P.: Editorial
in Health: the Nephron in Disease. Am. J.
(Jan.) 1960.

Efferse. P.: Relationship Between Endogenous
Creatinine Clearance and Serum Creatinine in
with Chronic Renal Disease, Acta Med. Scandinav.
434 (Feb.) 1957.

Gamble, J. L.: Chemical Anatomy, Physiology, and Path-
ology of Extracellular Fluid, ed. 5. Harvard University-
Press, 1947.

The Kidney
Med. 28:1-7

24-hour

Patients
156:429-

(a) Kolff, W. J., and Leonards. J. R.: Reducation of
Otherwise Intractable Edema by Dialysis or Filtration.
Cleveland Clin. Quart. 21:61-71 (April) 1954. (b) Kele-
men, W. A., and Kolff, W. J.: Use of Artificial Kidney in
the Very Young, the Very Old. and the Very Sick.
J.A.M.A. 171:680-634 (Oct. 3 1 1959.

(a) Summerskill, W. H. J.. Wolfe, S. .1.. and Davidson,
C. S.: The Management of Hepatic Coma in Relation to
Protein Withdrawal and Certain Specific Measures. Am. .1.
Med. 23:59-76 (July) 1957. (b) Sherlock. S.: Pathogenesis
and Management of Hepatic Coma. Am. J. Med. 24:806-
813 (May) 1968. (c) Stormont. J. M., Mackie. J. E., and
Davidson, C. S.: Observations on Antibiotics in the Treat-
ment of Hepatic Coma and on Factors Contributing to
Prognosis, New England J. Med. 259:1145-1150 (Dec. 11)
1958.

Kiley, J. E., Pender. J. C. Welch, H. F.. and Welch, C.
S. : Ammonia Intoxication Treated by Hemodialysis. New-
England J. Med. 259:1156-1161 (Dec. 11) 1958.
Papper, S.. Belsky, J. L.. and Bleifer. K. H.: Renal Fail-
ure in Laennec's Cirrhosis of the Liver: 1 Description of
Clinical and Laboratory Features. Ann. Int. Mel. 51:759-
773 (Oct.) 1959.

(a) Darby. J. P.. Jr.. Sorensen. R. J.. O'Brien. J. F., and
Teschan. P. E.: Efficient Heparin Assay for Monitoring
Regional Heparinization and Hemodialysis. New England
J. Med. 262:654-657 (March 31 I 1960. (b) Gordon. L. A.,
and others: Studies in Regional Heparinization: II Artifi-
cial-Kidney Hemodialysis Without Systemic Heparinization:
Preliminary Report of Method Using Simultaneous Infu-
sion of Heparin and Protamine, New England J. Me.l.
255:1063-1066 (Dec. 6) 1956.

Closing Remarks

Dr. Peschel

What is now actually the role of an arti-
ficial kidney in present day therapy? The
conditions leading to its potential use are
not too rare. Some have definitely become
more frequent in recent years — for instance,
acute renal failure associated (1) with
transfusion reactions, particularly those due
to the rarer incompatibilities such as Kell
antibodies; or (2) with septicemias from
antibiotic-resistant agents, such as staphylo-
cocci or gram negative organisms. Some ar-
guments against setting up an artificial kid-
ney laboratory, which is still rather expen-
sive, used to be about like this : "We have
achieved considerable success in managing
acute renal failure by conservative means ;
the chances for survival and recovery are
excellent in skilled hands ; the few patients
who are going to die will do so regardless
of how you treat them." Such arguments
are heard less and less. First, it seems we
have to revise a little the over-all mortality
rate of acute tubular necrosis treated by
optimal conservative management. What
seemed to be 20 per cent for a while, might
be closer to 50 per cent. Second, everybody
who has some experience with an artificial

kidney can enumerate a number of patients
whose lives were definitely saved by this
instrument.

Its usefulness should not be judged on a
statistical basis. The patients with acute
renal failure who are treated with it are
usually so desperately ill that the survival
rate will never be statistically impressive.
But one should look at the individual lives
which are saved by this means, usually for
a return to a fruitful and normal life.

So, because potential dangers to life are
present even in the apparently benign case,
it is highly desirable to have an artificial
kidney available, and one should know where
the nearest one is. It is obvious that this
is not an office procedure. Smaller hospitals
might have difficulties to have the necessary
manpower on hand, both in terms of num-
ber and of special experience. But larger
hospitals should have an artificial kidney
laboratory and the team prepared to run it.
Which patient should be dialyzed and at
which time, is a difficult decision which is
best made while the patient is observed in
the institution which has an artificial kid-
ney. Therefore, the patient should best be

November, 1960

PANEL DISCUSSION ON DIALYSIS

495

transferred as early as possible, before even
the transportation as such might be an ad-
ditional risk ; that means : without waiting
until dialysis seems unavoidable.

A number of other forms of dialysis have
been used. Among them, only peritoneal
lavage has proved of value. It is far less
effective than the artificial kidney is and
has its own technical drawbacks. But it is
simpler in its application, needs less per-
sonnel, and might at least be valuable for
areas where no artificial kidney is within
reach.

Within the last weeks, a new technique
of dialysis has been reported which you

might have read about. It is meant to allow
continuous hemodialysis or repeated pro-
phylactic dialysis, leaving small cannulas in
an arm artery and vein for a period of days
or weeks. They are connected to form an
AV shunt when not used for dialyzation, in
this way keeping the same vessels usable
again and again. It is perhaps too early to
say much about this but it might be prom-
ising.

We would like now to try to answer any
questions which might come from the audi-
ence.

Management of Childhood Nephrosis

William J. A. DeMaria, M.D.
Durham

A clinical disorder with no known cause,
cure or method of prevention and with a
high mortality rate is bound to have numer-
ous forms of therapy. Such is the situation
with so-called "pure" or "lipoid nephrosis"
of childhood, in the management of which
more than one hundred agents and proce-
dures have been applied.

Known causes of the nephrotic syndrome
do exist'1'. For example, it may be associ-
ated with diseases such as thrombosis of the
renal veins, constrictive pericarditis, or dia-
betes, or it may be due to poisoning with
heavy metals and poison oak or to drug in-
toxication with paramethadione ; but these
conditions will not be considered in this dis-
cussion.

Definition, Diagnosis, and Natural Course

Nephrosis may appear at any age but it
occurs most frequently between 18 months
and 4 years, with an estimated incidence of
2.1 per 100,000 children up to 9 years of
age' 2 1 n0 reaj evidence supports a direct
etiologic relationship between the disease
and preceding infection, climate, season,
diet, economic level, allergic history, or race.
In individuals, however, one or more of these
factors may affect the onset, the course of
the disease, or both. The incidence is higher
in males. The disease is reported in twins

Read before the Section on Pediatrics. Medical Society of the
State of North Carolina. Raleigh. May 11, 1960.

From the Department of Pediatrics, Duke University Medical
Center, Durham, North Carolina.

and in a second member of a family in about
2 to 3 per cent of cases'31.

Nephrosis is readily recognized when the
patient manifests edema, proteinuria, hypo-
proteinemia, and hyperlipemia. If one lim-
ited the diagnosis to patients with these find-
ings, however, other cases would go un-
recognized or be misdiagnosed. In the early
phase of the disease, or intermittently dur-
ing its course, a patient may manifest only
a significant proteinuria with doubly refrac-
tile or oval fat bodies in the urine. It may
be some weeks before the low serum pro-
teins, high serum lipids, and edema first
appear or reappear. Hematuria, hyperten-
sion, and nitrogen retention may accompany
the first known episode of nephrosis, and all
three features or any combination of them
may appear transiently during the course of
the disease.

Alert parents may note first the appear-
ance of periorbital edema. Because it fre-
quently is intermittent and slight, it is
passed off as a "cold." or an "allergy," or
the parent may feel that "the child just
needs more rest." During this phase the
urine almost invariably reveals the protein-
uria and usually the Maltese crosses under
the polarizing microscope141, whereas the
characteristic blood chemistry findings may
not be present. It is possible that the dis-
ease may remain in this subtle form until
irreversible renal changes become estab-
lished. The child may then first appear be-
fore the physician showing signs anil symp-

496

NORTH CAROLINA MEDICAL JOURNAL

November, 1960

toms of a terminal renal syndrome and no
previous recognizable history. Usually, how-
ever, after a period of weeks a generalized
edema becomes apparent and is the major
clinical symptom when the child is presented
for diagnosis. Urinalysis reveals the pro-
teinuria (1 or more grams per clay) and
Maltese crosses. Microscopic hematuria is
not uncommon, and gross hematuria with
red blood cell casts may be noted. One re-
port records microscopic hematuria in 50 per
cent of the cases during the first episode1'".
This "nephritic-appearing" urine may also
be associated with hypertension and nitro-
gen retention in either the first episode of
nephrosis or intermittently d u ring the
course of the disease, thereby causing some
confusion in diagnosis. However, the addi-
tional blood chemistry findings and marked
proteinuria characteristic of nephrosis usu-
ally aid in the differentiation of acute ne-
phritis and nephrosis. Aid is often avail-
able in a further analysis of the urine"1'.
In nephrosis the bloody urine is usually
bright red with a yellow supernate follow-
ing centrifugation, and the red blood cells
are well preserved. In nephritis, on the
other hand, the urine is brown, with a
brownish supernate in the majority of cases.
The red blood cells are less well preserved
in the nephritic urine (46 per cent as com-
pared with 84 per cent in nephrotic urine).
It is important to note that occasionally a
child with acute glomerulonephritis may
transiently (one to two weeks) show a low-
ered total serum protein and albumin and
elevated cholesterol71.

The natural course of nephrosis after on-
set is quite variable. The majority of pa-
tients will have a spontaneous remission in
about two months, followed in one to three
years by a series of exacerbations and re-
missions, either of which may last for weeks
or months. In rare cases the child may
never have a relapse after the first remis-
sion, while occasionally the disease may
progress rapidly, terminating in uremia and
death. Studies of two series of nephrotic pa-
tients two or more years after onset reveal
a range of apparent recovery between 18
and 41 per cent; continuing evidence of renal
disease between 17 and 31 per cent and
death between 42 and 51 per centIM. Be-
cause proteinuria a n d hypertension are
known to occur five years after "recovery"
and 20 years after onset"", these relatively
short-term follow-up figures do not afford

us sufficient knowledge for accurate prog-
nostics.

Remissions can occur following serious in-
fections— for example, pneumonia, or peri-
tonitis (most commonly pneumococcal), al-
though such infections as the latter were
the primary cause of non-renal deaths in
nephrosis. Exacerbations occur spontane-
ously, but may follow mild upper respiratory
diseases. As such infections, predominantly
viral, are so common in the age range when
the incidence of nephrosis is at its peak, the
relationship could be coincidental rather
than causal. Until a definitive process ini-
tiating nephrosis is identified and the pos-
sible influence of acute viral and bacterial
diseases is well documented, one must be
cautious in forming opinions based solely on
clinical observations. Most authorities, how-
ever, accept a relationship between infec-
tions and nephrosis. As discussed in the
section on treatment, methods for prevent-
ing infections and even the delaying of rou-
tine immunizations have been advised for
the prevention of recurrences.

Immunology, Pathology, and Metabolism

Experiments with both human and ani-
mal subjects suggest that an antigen-anti-
body reaction is basic to the production of
nephrosis, and that the predominant react-
ing tissue is the renal glomerulus'"". Serial
determinations of serum complement reveal
a progressive decrease in concentration pre-
vious to a relapse, continued low levels while
the disease is active, and a gradual rise just
prior to remission. Since the low comple-
ment levels are not due to loss or decreased
synthesis, it is presumably bound by the
antibody reaction at the glomerulus"".

The most consistent pathologic findings in
the various stages of clinical nephrosis have
been noted in the epithelium of the glomeru-
lar capillaries'1-'. The normal capillary con-
sists of three components. The inner lining
— endothelium — is enveloped by the base-
ment membrane, which in turn is sur-
rounded by a layer of epithelium. Normally
the epithelial cytoplasm is differentiated into
numerous foot processes, which impinge on
the outer aspect of the basement membrane.
These processes are greatly decreased in
number in all stages of nephrosis, and in-
stead broad masses of epithelial cytoplasm
are applied to the basement membrane. Far-
quhar and associates'12' speculate that this
epithelial alteration may be secondary to

November, 1960

MANAGEMENT OF CHILDHOOD NEPHROSIS— DEMARIA

497

changes in the basement membrane which
are inapparent under the electron micro-
scope at this time. Later in the course of the
disease areas of changed density in the base-
ment membrane give it a moth-eaten ap-
pearance. Such a change would allow pro-
tein to leak from the glomerular capillary
and possibly account for the supra-normal
glomerular filtration rate noted early in the
disease. The changes in the epithelium are
thought possibly to reflect an attempt by
the capillary to repair the holes in the base-
ment membrane.

The changes noted in the basement mem-
brane and endothelium appear to depend on
the duration and severity of the disease.
Thus the irregular thickening, decreased ho-
mogeneity, and moth-eaten appearance of
the basement membrane become increasing-
ly more apparent as the clinical disease pro-
gresses.

These recent findings are particularly in-
teresting when compared with earlier clin-
icopathologic observations of Blackman"31.
He noted that the clinical progression of the
many forms of Bright's diseases are corre-
lated with high concentrations of protein-
uria (more than 0.5 Gm. per 100 ml.),
of which 35 per cent or more is often
found to be globulin. He proposed that con-
tinuing exposure of the glomeruli to high
concentrations of globulin promotes crescent
and adhesion formation, with resultant loss
in renal function. His studies suggest that
if the concentration of protein in the glo-
merular filtrate could be decreased, the
progress of the renal disease might be re-
tarded or prevented.

Support for this contention is offered by
the observation that nephrosis progresses to
renal failure more often in children if uri-
nary protein loss exceeds 6 Gm. per 24 hours
and the urinary globulins exceed 45 per cent
of the total urinary protein'141.

The increased permeability of the glo-
merular basement membrane permits mas-
sive proteinuria, most of which is albumin.
However, as reported above and else-
where'1"', considerable loss of globulin, par-
ticularly the alpha fraction, may occur. The
hypoalbuminemia is chiefly due to urinary
losses, since synthesis of protein is normal
or increased. An increase in the catabolism
of plasma albumin, however, is an additional
cause of hypoalbuminemia'161.

The elevated serum lipids (cholesterol,
triglycerides, and phospholipids) are mostly

bound to protein, and appear as low-density
beta-lipo proteins"71. The hyperlipemia may
be initiated by the fall in albumin, since it
is suggested that albumin acts as a trans-
port mechanism for egress of cholesterol
from the plasma to the bile. The triglyceride
group of lipids rises first, followed by a rise
in phospholipid and cholesterol'1"1. Persist-
ence of a high cholesterol value with normal
albumin makes it difficult to accept this sug-
gestion unless the transport defect may be-
come irreversible. Further contradictory
evidence is noted in one form of experi-
mental nephrosis in which the hyperlipemia
precedes the hypoproteinemia'19'.

The mechanism of edema formation in
nephrosis is also complex. Loss of albumin
causes a decrease in blood volume, which
stimulates the hypothalamic receptors to se-
crete antidiuretic hormone, resulting in
water retention'2"1. Increased secretion of
aldosterone also occurs and causes tubular
reabsorption of sodium, with further reten-
tion of water'211. Other mechanisms contrib-
uting to edema beside low albumin must be
considered in those rare cases of nephrosis
associated with edema but with normal plas-
ma proteins. Just as puzzling are the cases
associated with hypoalbuminemia but no
edema(la- 51.

Although it appears likely that the pri-
mary process is in the kidney, it is difficult
to account for some of the extrarenal meta-
bolic dysfunction noted in nephrosis on this
basis alone. A more widespread lesion oc-
curring either as a primary immunologic re-
sponse or secondary to a substance formed
by such a response in an organ or a system
may cause, for example, capillary damage
and abnormal permeability to plasma pro-
tein. A similar suggestion has been used to
explain either the selective or the general-
ized nature of acute glomerulonephritis'221.

Management

Until recently little help could be offered
the child with nephrosis except attempts to
alleviate his edema. As a result, a number
of measures ranging from watermelon ex-
tracts to malarial infection were tried.
Transient effects may result from intraven-
ous administration of hyperoncotic plasma
substitutes such as human serum albumin,
hypertonic dextran and polyvinylpyrrolidone
(P.V.P.). Diuretics [for example, xanthines,
mercurials, urea, azetazolamide (Diamox)
and chlorothiazide (Diuril)] are generally

I'.tN

NORTH CAROLINA MEDICAL JOURNAL

November, 19(50

ineffective, and in some instances probably
contraindicated.

Low-sodium, low-protein, high-protein,
and low-fat, low-salt, low-protein (rice)
diets have been advocated, but no one spe-
cific diet has proven universally beneficial
for nephrosis. In some instances these diets
may even be detrimental if not used with
discretion.

It is unfortunate that our current therapy
is still partly based on assumptions, over-
simplifications, opinions, and clinical
hunches. However, the following is the sim-
plified and tenuous schema of some factors
involved in nephrosis upon which our man-
agement is based :

An immunologic response increases the
permeability of the glomerular capillaries,
causing hypoproteinemia (primarily hypo-
albuminemia) which results in hypovolemia.
Physiologic compensation follows and salt
and water are retained via the actions of
antidiuretic hormone and aldosterone, re-
spectively. If marked proteinuria continues,
especially if a high proportion is globulin,
the basement membrane of the glomerular
capillaries suffers further injury which may
become irreversible. Both viral and bacte-
rial infections may impede the progress of a
natural or induced remission, or provoke an
exacerbation.

The primary aid of therapy is to block or
reverse the reaction causing the increased
capillary permeability. Corticoids appear to
suppress this reaction, and early in the
course of nephrosis induce a complete re-
mission in the majority of cases. Antibiotics
control mosi, and prevent some, of the com-
mon bacterial diseases. The viral diseases
are best prevented by eliminating unneces-
sary exposure to groups of people, especially
when epidemics are present.

As soon as the diagnosis is confirmed the
following program is started :

1. Treatment of any existing infection or
the prophylactic use of antibiotics
while corticoids are being adminis-
tered.

2. Thirty-six to forty-eight milligrams of
either triamcinolone (Aristocort), or
6 methyl-delta-1-hydrocortisone (Me-
drol) given in equally divided doses
every six hours orally.

?,. Potassium chloride, 1 to 3 Gm. given
orally per clay, although the higher
dose is unnecessary with the newer
corticoids.

4. A balanced diet without added salt or
highly salted foods. A decrease in pro-
tein intake may be advisable during
and period when nitrogen retention
is noted'-'.

5. A modified rest program unless mas-
sive edema is causing considerable dis-
tress.

(i. Abdominal paracentesis or thoracen-
tesis if severe respiratory difficulty or
infection is suspected.

7. Continuation of this program until
complete chemical and clinical remis-
sion occurs. If at the end of four weeks
no remission has occurred, taper off
corticoids in about one week and ob-
serve for two or three weeks. If spon-
taneous remission does not occur, re-
peat original course.

8. Institution of an intermittent program
the week following initial remission
and complete tapering of daily corti-
coids. Dosage for continuing suppres-
sion ranges from 12 to 48 mg. of Me-
drol or Aristocort daily, and is given
orally in three divided doses on three
successive days of each week. This
program is continued for about nine
months, following which the tapering-
off precedure is begun by decreasing
the total daily dose by 4 mg. each
week. Prophylaxis with penicillin or
sulfa is continued for about one year
after proteinuria is last recorded. Rou-
tine immunizing procedures are de-
layed for an additional year. Acute
infections are treated with the appro-
priate antibiotic and the corticoids are
cut by about one-third to two-thirds
of the total dose during the active in-
fection period.

If signs of relapse appear during the pro-
longed period of corticoid treatment, the
drug is given daily until suppression occurs.
Following this, the regular consecutive three
day per week program is reinstated. If a
relapse occurs months after completion of
the one year's corticoid treatment, the same
schedule is repeated except that the corti-
coid is given for a shorter period (three to
six months) after suppression is established.
If the child fails to respond to corticoids and
progression of renal damage is apparent, it
may be advisable to try a combination of
corticoids and mechlorethamine (nitrogen
mustard)'-4'.

November, 1960

MANAGEMENT OF CHILDHOOD NEPHROSIS— DEMARIA

499

Although a review of our patients man-
aged under this program will be published
at a later date, one interesting observation
is appropriate to this discussion.* In the
corticoid induced remission, it is difficult to
know whether a complete remission or sim-
ply suppression of activity exists. The sedi-
mentation rate is a useful indicator of activ-
ity, and is frequently an aid in determining
the duration and intensity of corticoid ther-
apy'^'. Unfortunately, its alteration with
commonly occurring acute infections occa-
sionally interferes with the reliability at a
time when such an indicator is sorely needed.
For this reason we are making simultane-
ous determinations of the Weltmann serum
coagulation band (C.B.)'2''. Nephrosis is one
of the rare conditions associated with a
C.B. of 0 (the normal being 6). In the pres-
ence of acute upper respiratory and strep-
tococcal diseases, the C.B. usually is 4-5 and
3-4 respectively. Thus far our experience
suggests that the Weltmann reaction is more
reliable than the sedimentation rate in those
uneasy moments when a nephrotic patient
in remission or in a period of corticoid sup-
pression suffers an acute infection, during
which an elevation of the sedimentation

i rate and a transient appearance of slight
proteinuria occurs.

A further value of the Weltmann reaction
is illustrated in the following two cases. The
first patient was a child admitted with
edema, hypertension, proteinuria, and gross
hematuria, with red blood cell casts. The

| marked edema and proteinuria led us to sus-
pect nephrosis. Her blood chemistry values
and a Weltmann reaction of 0 confirmed the
diagnosis of nephrosis. The second was a
child with apparent acute glomerulonephri-
tis whose blood chemistry values were con-
sistent with nephrosis. His Weltmann reac-
tion was 4. His blood chemistry levels re-
turned to normal in three weeks and the
nephritis has been completely resolved.

Twenty of our most recent patients are
being treated with either Medrol or Aristo-

| cortt. Other than the appearance of some
moon facies and changes in temperament
(somewhat irritable either while on or off
the drug in the consecutive three day per
week program), no complications have re-
quired the discontinuance of either drug.

*Part of this study was supported by a grant from the North
Carolina Chapter of the National Nephrosis Foundation, Inc.

tMelrol supplie! by the Upjohn Company. Aristocort sup-
plied by Lederle Laboratories, Division of the American Cy-
anamid Company.

Two of our patients continue to show in-
termittent proteinuria several months after
corticoid withdrawal, although no other
signs of nephrosis are apparent. Further
testing revealed both to have orthostatic pro-
teinuria. Whether this condition antedated
the nephrosis or is similar to the transient
post-nephritic orthostatic proteinuria'2'11, or
is a residual effect of nephrosis is not an-
swerable at this time.

Pooled figures reveal that four years after
the onset of nephrosis, 60 per cent of the
patients treated in the immediate precorti-
coid period were alive, whereas slightly more
than 75 per cent of those treated with corti-
coids were alive'27'. This difference points
out that at least the nephrotic patient has a
higher immediate survival rate. Further ob-
servations are also encouraging :

1. Chemical remission is induced with
successful corticoid treatment as men-
tioned earlier (recently reviewed) (2S).

2. Serial studies of renal biopsies with a
light microscope reveal a histologic im-
provement with corticoids'29'.

3. Similar studies with electron micro-
scopy demonstrate the histologic dis-
turbance returns to normal'""'.

In addition, current therapy decreases the
need for prolonged hospitalization formerly
required for episodes of massive anasarca,
which was so distressing for both child and
family. As long periods of bed rest at home
are no longer routinely necessary, the psy-
chologic gains for all concerned are immeas-
urable. The majority of these children are
of pre-school age, and restricting large
group contacts is not difficult. Most school
authorities make some provision for teach-
ing home-bound children, thus enabling them
to keep up with their classes. If the family
lives in a city or apartment and cannot con-
veniently move to a less densely populated
area, a visiting nurse can be of considerable
help in educating the neighbors to the need
of preventing needless contacts of the ne-
phrotic with carriers of infection.

In conclusion, one aspect of overall man-
agement should be emphasized. It appears
that the earlier current treatment is started,
the better the immediate prognosis. Thus,
one wonders if, in spite of the low incidence
of nephrosis, routine testing of urine is not
advisable two or three times each year for
all children aged 1-6 years. Such a routine
is even more important in a family with one
nephrotic patient already under treatment.

500

NORTH CAROLINA MEDICAL JOURNAL

November, 1960

Adequate explanation to the family should
precede such a procedure in order to prevent
any undue concern.

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of Nephrosis: Statistical Evaluation and Proposed Ap-
proach to Therapy, Pediatrics 23:561-569 (March) 1959.

28. Riley, C. M.: Treatment of Nephrosis with Anti-inflamma-
tory Steroids. Ann. New York Acad. Sc. 82:957-962 (Oct.
14) 1959.

29. Galan, E.. and Maso, C: Needle Biopsy in Children with
Nephrosis: A Study of Glomerular Damage and Effect of
Adrenal Steroids. Pediatrics 20:610-625 (Oct.) 1957.

30. (a I Piel. C. F.. and Williams. G. F.: Long-continued
Adrenal Hormone Therapy in Childhood Nephrosis, J. Am.
Med. Women's Assoc. 12:273-279 (Sept.) 1957. (b) Ver-
nier, R. L.. Farquhar, M. G., Brunson, J. G.. and Good,
R. A.: Chronic Renal Disease in Children. A.M.A. J. Dis.
Child. 96:306-343 (Sept.) 1958.

November, 1960

501

Remarks by Governor Luther H. Hodges
At the North Carolina Governor's Conference on Aging

Hotel Sir Walter, Raleigh
Wednesday, July 27, 1960—8:00 p.m.

Mr. Chairman and fellow citizens :

Welcome to this Conference. I commend
each of you for the interest in your commun-
ities and in your state which you demon-
strate by your presence here tonight. You
are giving your time and your energy be-
cause of your interest in the special problems
and needs of our older citizens.

May I emphasize at the outset that I do
not assume or believe that the older persons
in our state present unusual and special
public problems to the extent that we should
isolate this particular group from all other
citizens, and set them apart from the main
stream of our citizenship.

Our governments have certain responsi-
bilities that apply to all citizens, without re-
gard to age classifications. We do know and
recognize that some problems are peculiar
to particular age groups. Thus, on one oc-
casion, we will need to give particular atten-
tion to the public problems regarding the
health of all citizens, or regarding the mat-
ter of heart disease, or the prevention of
tuberculosis. At another time we will need
to have conferences to give particular em-
phasis to the problem of highway safety —
which certainly affects citizens of all age
groups. At still another time, we find it de-
sirable and necessary to have conferences on
such subjects as education, which have tre-
mendous impact on the well-being and pro-
gress of all citizens.

I have said all of this in order to attempt
to place this particular conference in proper
context. I am sure our older citizens would
like to have me do this. I think it is impor-
tant that all of us avoid the erroneous im-
plication that the older citizens of North
Carolina present today overwhelming public
problems which weigh heavily on the shoul-
ders of all other citizens. At the same time.
we know that with the increasing longevity
of people in this country we do have an in-
creasing number of citizens who reach the
age of sixty-five and over. It is estimated at
the present time that there are about 310,000
North Carolinians in the age group of sixty-
five and over. While the total population of

our State has doubled in the last half cen-
tury, the number of older people in this par-
ticular age group has increased four times
during the same period.

This of course means that the elder citizen
group comprises a much higher proportion
of our total state population than it has in
previous years, amounting in 1960 to ap-
proximately 6.7 per cent of the total popu-
lation in the age group of sixty-five years
and older.

The increase in the numbers in the older
population group has been particularly rapid
during the past decade, and during the past
ten years the increase in this particular age
bracket has been 37.5 per cent, compared
with a total state population increase of ap-
proximately 11 per cent.

This State Conference is of course a pre-
lude to a National Conference which is
scheduled to be held in Washington, D. C,
in January 1961. The Conference here this
evening has been organized and planned by
a group of fifteen persons whose profession-
al activities include special knowledge of
services to the older group of our population.
These fifteen persons are members of the
North Carolina Governor's Coordinating
Committee on Aging which I appointed in
the fall of 1956 and to whom I wish to ex-
press at this time my personal appreciation
for the service they have rendered the State
as members of this Committee.

At the time I appointed this special Com-
mittee in 1956 I asked them to accept the
responsibility of (1) reviewing current ac-
tivities within North Carolina to meet any
special needs or problems of the increasing
number of older citizens; (2) to evaluate
growing special needs and to suggest meas-
ures by which these special needs or prob-
lems might be met; (3) to report from time
to time on matters in this particular area.

Some time ago the United States Congress
enacted legislation calling for the 1961 White
House Conference on Aging. This Confer-
ence here tonight is a part of the activity
and planning taking place in all states and
we hope that this particular Conference will

502

NORTH CAROLINA MEDICAL JOURNAL

November, 1960

serve at least two major purposes: (1) to
help us in North Carolina better understand
the problem of this area and to help us de-
termine the best course of action we can pur-
sue within our own State during the coming
months and years; and (2) to develop find-
ings and recommendations which can be
passed on to the National Conference there-
by made available to the Nation as a whole.

I am sure each of you will agree with me
that you have in this Conference a very con-
siderable task in really coming to grips on
these matters and really achieving the de-
sired purposes of this Conference. I know
that you share with me the hope and the
confidence that this Conference will not be
just another meeting at which many persons
come together for pleasant but rather gen-
eral discussions, and at the conclusion of the
meeting disperse to their respective homes
and occupations without much information
or inspiration.

I am informed that tomorrow those at-
tending this Conference will divide into eight
groups and each group will give particular
study to a different but important area of
interest relating to the over-all subject of
the aged. I would like to comment just brief-
ly about these particular topics which you
will be discussing in detail on tomorrow.

Research and Population

One of your groups will give attention to
the topic of research and population. I know
that you will be pleased to learn that there
are important research activities going on
at the present time at North Carolina State
College with particular emphasis on our
rural population. And the Duke University
Center on Aging is making good progress in
the promotion of research, the training of
investigators and the development of scien-
tific knowledge in the field of aging. Un-
doubtedly there are more examples of such
activity in our State and I hope these will
be brought out in your discussions tomor-
row. Most of us in North Carolina need no
selling as to the importance of research,
whatever the subject matter under consider-
ation. We are research-minded ; we are re-
search-enthusiasts : and we are research-
committed. Also, we do not permit ourselves
to be restricted to orthodox research activity
in graduate schools of educational institu-
tions. We don't hesitate to stride forward
and make a bold venture into a completely

new arena of research activity. I have refer-
ence to the Research Triangle, of which I am
sure all of you have heard, and which repre-
sents in its opportunity for the promotion of
industrial research a beneficial partnership
between the industrial laboratory on the one
hand and the academic laboratory on the
other.

Another one of your special topics tomor-
row will be entitled Income Maintenance and
Employment. In what is perhaps less sophis-
ticated language, this topic deals with the
personal incomes of our older citizens or
whether they have sufficient income to get
along. As you well know, much of my in-
terest and energy have been tied up with the
income improvement of all North Carolina
citizens.

Increasingly, in recent years, our State
employment offices have given more atten-
tion and made more effort to educate people
and particularly employers on the potential
advantages in reducing hiring restrictions
which are based on age. The first step in this
process was to give some education attention
first to the personnel of the 54 local Employ-
ment Security offices. An employment coun-
sellor has had the advantage of some special-
ized training.

According to statistics which I saw a few
days ago, during the past two years our
State Employment offices have had 52,000
new applicants over 45 years of age who
have filed applications for employment. Of
this 52,000 persons over 45 years of age,
more than 38,000 have been placed in gain-
ful employment. Many of these were in addi-
tion to being older citizens physically handi-
capped in some way. If you make a quick
calculation, you would ascertain that of the
total number of applicants processed by the
State Employment offices during the past
two years, in the age group 45 or older, some
16,000 applications still remain in the active
files, and so far as the statistics indicate, this
is a problem group of citizens who have ex-
pressed a desire to secure employment but
who apparently have not done so. Of course,
we can assume that many in this group of
16.000 did in fact secure employment or had
some change in their situation which would
remove them from the active application list
but who did not report this change in their
status to the Employment offices. Many older
citizens have a problem of getting jobs be-

November, 1960

REMARKS BY GOVERNOR HODGES

503

cause of the employment "age policies" of
various firms and agencies.

Another aspect of the topic relating to in-
come has to do with the matter of retire-
ment pay. The Social Security program is
the most important and most effective sys-
tem of retirement reaching the mass of our
citizens. During recent years Social Security
benefits have been improved, the retirement
systems of our state government and in
many instances the systems of local govern-
mental units have been coordinated with So-
cial Security, a development which has been
of particular benefit to older citizens whose
retirement was imminent. During recent
years retirement benefits under our State
system have been improved substantially.
Teachers or State employees retiring now
are receiving more than twice (and some-
times three times) as much as they would
have received prior to 1955.

A third aspect of this income topic deals
with that fairly large number of elderly cit-
izens who are not employed and who are not
physically capable of engaging in productive
employment. Neither are many of the per-
sons in this group participating in any re-
tirement system, Social Security or other-
wise. Or if persons in this group do have re-
tirement type income, it generally consists
of minimum Social Security payments which
are inadequate to meet minimum day-to-day
living needs. For these older citizens who
are not employed, and who have inadequate
income from retirement or other sources,
they must rely on payments from public
funds under the welfare program. I am
hopeful that the welfare payments of the
State in the future will be increased as the
income of the State increases.

Perhaps by some time in the decades
ahead we will have reached the point where
practically 100 per cent of all citizens who
have reached the age of 65 and older will
have participated in far more complete and
effective retirement systems during the years
of their gainful employment so that when
they get to the age of retirement, their re-
tirement compensation will be at compara-
tive levels far above that which is now gen-
erally available, whether under Social Se-
curity or other retirement systems, and per-
haps the time will come when the number of
older citizens requiring direct welfare assist-
ance will be much less percentage-wise than
what we have in this day and time.

Still another topic which some of you will
consider tomorrow will be the subject of
health and medical care for the aged. I will
not attempt at this time to go into detail as
to what is done presently under govern-
mental programs or as to what is currently
under consideration and what we may fore-
see perhaps in the near future. Much is be-
ing done today that was not being clone
twenty years ago. There are some obvious
needs today which demand organized action
which can only come through the agencies of
our government. Exactly what programs
should be adopted for the future is a matter
involving some considerable differences of
opinion and will be discussed in the coming
political campaign. Whichever way these
specific questions are resolved, I am confi-
dent that within the next few years our Na-
tion as a whole will in fact make great pro-
gress in providing better and more adequate
health and medical care for the older citizens
of the Nation, as the problem is becoming
more acute every year.

In the meanwhile, with regard to medical
aid and other kinds of aid and needs, is it too
much to hope for to feel that children and
close relatives of our older citizens will show
more interest and become more helpful per-
sonally than many are now doing? Imper-
sonality and institutionalizing leave much to
be desired in appraising the future of our
older citizens who find themselves in need.

Other items which will be considered at
the topic of social services which are avail-
able to our older citizens, including special
activities by family service agencies. Red
Cross chapters, mental hygiene clinics, as
well as local departments of public welfare;
and the topic of housing and living arrange-
ments which cannot, I think, be isolated and
dealt with in a vacuum apart from the other
specific subjects I have mentioned. Then,
there is the topic of education. It is especial-
ly good that there is a growing emphasis on
encouraging older citizens to participate in
organized adult education activities. We
really never get too old to learn and the
older citizens, no less than young citizens,
have a richer and more meaningful life if
their minds are occupied and stimulated by
individual educational endeavors. An impor-
tant facility in organized educational activ-
ities for older citizens are the libraries of
the State, which will also be a separate topic
for vour discussion.

.-.Ill

NORTH CAROLINA MEDICAL JOURNAL

November, 1!)(!0

Recreation, family and community rela-
tionships, religion, and personnel round out
the list of specialized topics for your dis-
cussion.

I would like to close my remarks on sub-
stantially the same theme with which I be-
gan, and that is we should not make the
mistake of proceeding on the assumption
that the older citizens in our population are
somehow a physically separate group which
stands apart, which stands even outside the
main stream of society. As a matter of fact,
our older citizens are composed of parents
and grandparents who live in our homes and
who work in our communities, citizens
whom we see at church on Sundays, as well
as citizens who may be restricted to their
homes by ill health. This group also of

course includes those who are in institutions
or nursing homes. Certainly, for the most
part, the group of older citizens in North
Carolina are an integral and inseparable
part of our total citizenship group. I think
then that to the extent that we develop ef-
fective ways and means to enable older citi-
zens meet their own problems, whether
financial or otherwise, and to do this in a
way which maintains them as integral parts
of our community, maintaining the thread
of family relationships and community re-
lationships, then we shall be more successful
in our efforts on behalf of the older citizens.

This Conference has a great opportunity
to make a significant contribution in the
public interest, and I wish you every success.

The Health and Adjustment of the Aged Person

EWALD W. Busse, M.D.
Durham

I am pleased to have an opportunity to
share ideas with the participants in this
conference. I know that the citizens of
North Carolina are sincerely interested in
the problems of elderly people, and are de-
termined to do their part to help solve these
problems. When I talk to representatives of
national organizations and officials of the
federal government, I am proud to tell them
that I come from North Carolina, because
these informed lay and professional people
are aware of the progress our state has
made in the field of aging. Under the able
leadership of many of the persons gathered
here today, North Carolina will continue to
be in the forefront of states seeking to solve
the many health and social problems that
confront our elderly citizens.

The Meaning of Health

According to the constitution of the World
Health Organization (WHO), drafted in
1946, "Health is a state of complete physical,
mental, and social well being and not merely
the absence of disease or infirmity." This
definition represents an ideal, a state of per-
fect health. If it were rigidly applied as a

Delivered at the Govern
July 28, 19B0

From the Department of Psyehiatr
ieal Center, Durham. North Carolina.

Conference on ARinp, Raleigh,
Duke University Med-

measuring device, there is probably no liv-
ing person who would qualify for any rea-
sonable length of time as being healthy.
This definition recognizes that health is a
composite state, involving the mind and the
emotions, as well as the body.

If we could eliminate all disease from a
group of people 60 years of age or older,
would they really be healthy? Probably not,
according to this definition. Even in the ab-
sence of disease, they would have many so-
cial problems which would, in turn, produce
mental conflicts. In addition, they would be
affected by the biologic problem of primary
aging. Most people doing medical research
in the field of aging distinguish between
primary and secondary aging. Secondary
aging refers to the loss of function which
results from a disease process, while pri-
mary aging is a process in itself — a process
of change resulting solely from the passage
of time. In the human organism, unfortu-
nately, the changes wrought by time are
often associated with declines in function :
alterations of perception, reduction in speed,
diminution in strength, and so forth.

In WHO's definition of health, the idea
of adjustment is contained in the words "so-
cial well being." When health is conceived
as such a complex state, it is obvious that
physicians are not capable of carrying out

November, 1960

HEALTH AND ADJUSTMENT OF THE AGED— BUSSE

505

all the functions necessary to make people
healthy. Physicians are trained to be inter-
ested primarily in the person as a biologic
unit. The physician who recognizes that the
mind and body are inseparable parts of this
total biologic unit, and that the environ-
ment in which this unit functions determines
many of its reactions, will necessarily be in-
terested in society — that is, in the effect of
the environment upon the health of the indi-
vidual. Medical research can help to identify
the types of social stresses that are apt to
disrupt the functioning of the individual,
and the physician can recommend altera-
tions in social patterns which will reduce
such stresses ; but in our democratic system
society must provide the means and methods
of making the environment favorable.

Sometimes groups within our society take
it upon themselves to alter the social envi-
ronment without a reasonable basis for such
action. There are some, for instance, who
believe that a society in which things are
"easy" is conducive to health — that is, that
an individual's health and happiness are in
inverse proportion to the amount of effort
required for him to live. According to their
theory, an easy life is less stressful. Unfor-
tunately (or perhaps fortunately), this the-
ory does not hold true. The biologic unit
has certain energies that must be expended.
When the expenditure of such energies is
prevented, they are stored up and produce a
powerful force which, if not properly re-
leased, can be very destructive to the body
and to the mind. In my opinion, all people
have a need or a drive to maintain self-
esteem by contributing to the lives of others
as well as to their own. If life is oversimpli-
fied, the opportunity to utilize energy in
maintaining self-esteem may be restricted.
A society which says to its citizens, "Take
it easy ; don't work. We will take care of all
your needs," can destroy the only outlet that
many people have for their energies, and
thus lead to their illness and death. Medical
science knows that people can die when they
feel they have no purpose for living and no
goal in life.

Factors Influencing the Life Span
Longevity is determined by a number of
factors. Attempts have been made to dem-
onstrate that the life span of mammals is
related to body size : the larger the animal,
the longer the life span. This theory breaks
down when one considers the relatively short
life span of cows, horses, and even elephants

(90 to 100 years) as compared to that of
man. On the assumption that aging begins
with maturity, it has been postulated that
the theoretical life span of a species can be
calculated by determining the age at puberty
and multiplying thi's figure by a constant
(13). This hypothesis works out reasonably
well for calculating the life expectancy of a
mouse or a rat; but if man's adolescence is
assumed to begin between 13 and 16 years
of age, the expected life span of human be-
ings would be 169 to 208 years. On the basis
of this theory, many people have speculated
that man's life span can be and should be
greatly prolonged.

Other calculations of life expectancy are
based on the ratio of brain weight to body
weight, the length of gestation, the meta-
bolic rate, and the pulse rate. Rough corre-
lations exist for each of these variables, and
provide interesting bases for speculations.

From recent experiments, it appears
doubtful that a fixed life span exists for
any particular animal. Immature rats kept
on a diet adequate in the essential elements
and vitamins, but deficient in calories, are
delayed in growth and maturation. The av-
erage life span of these rats is considerably
greater than that of rats given a diet suf-
ficient to enhance growth and the onset of
puberty.

While it is obvious that genetic factors in-
fluence longevity, much more information is
required before their influence is completely
understood. An example of some of the puz-
zling facts that have been uncovered is the
finding that the life span of succeeding gen-
erations of rodifers, a small aquatic animal
made up of approximately one hundred cells,
can be greatly increased by selecting eggs
from young mothers to propagate each gen-
eration. When eggs from old mothers are
used, the life span declines sharply. In this
experiment, at least, parental age is an im-
portant determinant of the life span. When
eggs from the mother with a shortened life
span are utilized while she is still young,
the offspring will have normal longevity.
This finding is taken as evidence that the
shortened life span is not caused by a gene
mutation. Apparently a hereditary but non-
genic factor is responsible.

The influence of genetics on the human
life span is difficult to evaluate. It does ap-
pear, however, that reasonable predictions
of an individual's life expectancy can be
made by utilizing a factor referred to as the

501!

NORTH CAROLINA MEDICAL JOURNAL

November, 1900

"total immediate ancestral longevity" — that
is, the sum of the life span of his two par-
ents and four grandparents. It should be
made clear that at present we know of no
gene responsible for extension of the life
span, but do know that genes which in-
crease susceptibility to malfunctioning and
disease may shorten the life span.

Our present knowledge of the factors in-
fluencing longevity may be summed up as
follows :

1. Life span appears to be related to rate
of growth ; accelerated growth is fol-
lowed by accelerated aging.

2. It can be correlated to a reasonable
extent with the ratio of body weight
to brain weight, and with metabolism,
heart rate, duration of gestation, and
other physiologic factors.

3. It is influenced by the age of the moth-
er and the life span of ancestors. While
the hereditary determinant is largely
nongenic, life-shortening genes may
be passed on through successive gen-
erations.

The Aim of Medical Research in the Field
of Aging

With advancing years, all of us become
more subject to multiple ailments that inter-
fere with interpersonal relationships, de-
crease employability, and necessitate pro-
longed periods of bed rest or hospitalization.
Scientific advances have made it possible for
a high percentage of our population to reach
old age. This is surely a worth-while achieve-
ment, but it is now the responsibility of
science and of society to improve the health
status of our old people, so that they can
contribute to society instead of becoming an
excessive burden which seriously disrupts
our way of life.

Public Health Monograph No. 30, pub-
lished in 1955 by the United States Depart-
ment of Health, Education, and Welfare, in-
dicates a clear correlation between age and
the frequency of different types of illnesses.
Above the age of 45 years, three diseases —
mental illness, heart disease, and arthritis
— were, in that order, responsible for most
of the disability measured in terms of days
lost from work. After the age of 65, heart
disease and arthritis were the leading causes
of disability. In terms of days in bed, dis-
eases of the heart led the list of disabling
illnesses, being followed by nephritis, ma-
lignant neoplasm, and cerebral hemorrhage,

embolism, and thrombosis. The two major
causes for prolonged hospitalization were
(1) diseases of the heart and (2) mental
and neurologic diseases.

The incidence of various chronic diseases
differs in the two sexes. Hospital admis-
sions because of cerebral arteriosclerosis,
for example, are more frequent among men,
while senile dementia is a more frequent di-
agnosis in women for whom hospitalization
is required. On the other hand, the four
major causes of death are the same for both
men and women past 65: (1) diseases of
the heart, (2) cerebral hemorrhage, embol-
ism, and thrombosis, (3) all malignant neo-
plasms, and (4) hypertension and arteri-
osclerosis.

In an effort to minimize or prevent
changes associated with aging, and to elim-
inate diseases which reduce a person's pow-
er to think, feel, perceive, and respond, med-
ical research is being directed less toward
merely prolonging life and more toward in-
creasing and maintaining the functioning
efficiency of the mind and body. If this aim
can be accomplished, more and more elderly
people will be able to meet their own needs
and to fulfill a meaningful role in society.

One of the first steps necessary in this
program of research is to separate disease
processes from the aging process per se.
Atherosclerosis, for example — a condition
that until recently was attributed to the
aging process — is now known to be a meta-
bolic disorder not necessarily related to ag-
ing, but affected by hereditary determinants
and a host of other influences.

Medical Problems Created by Our
Aging Population
Since the turn of the century the average
life span in our country has been greatly
increased. The remarkable decline in the
death rate of infants during the past 50
years accounts for the fact that while the
population of the United States has doubled,
the number of persons over the age of 65
has quadrupled. There are between 15 and
16 million people in the United States above
65 years of age. By 1970 this number will
be increased to approximately 20 million.

Increasing incidence of chronic diseases

Unfortunately, this remarkable increase
in life expectancy has been accompanied by
an increase in the number of individuals
disabled by chronic disease or confined to a
bed or an institution. More than one mil-

November, 1960

ADVERTISEMENTS

XXXVII

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TRIDIHEXETHYL

lODIDEt
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STOMATITIS

VISUAL DISTURBANCES

»

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0%

0%

0%

0%

9%

0%

5%

23%

62%

15%

METHANTHELINE
BROMIDE

72%

28%

50%

18%

0%

3%

0%

5%

25%

52%

23%

ATROPINE SULFATE

46%

14%

34%

11%

0%

9%

6%

14%

17%

37%

46%

PLACEBO

5%

0%

1%

0%

2%

24%

50%

*Atwater, J. S., and Carson, J. M.: Therapeutic Principles in Management of Peptic Ulcer. Am. 1. Digest. Dis. 4:1055 (Dec.) 1959.

tPATHlLON is now supplied as tridihexethyl chloride instead of the iodide, an advantage permitting wider use, since the latter could
distort the results of certain thyroid function tests.

«fe-fe) LEDERLE LABORATORIES, A Division of AMERICAN CYANAMID COMPANY, Pearl River, New York

control the tension - treat the trauma

Concerning Your Health and Your Income

A special report to members of the Medical Society of

the State of North Carolina

on the progress of the Society's

Special Group Accident and Health Plan

in effect since 1940

PROUDLY WE REPORT 1959

AS OUR MOST SUCCESSFUL YEAR IN SERVING YOUR SOCIETY.

During the year we introduced a NEW and challenging form of disability protec-
tion. There has been overwhelming response on the part of the membership.

Participation in this Group Plan continues to grow at a fantastic rate.

1960

is our 20th year of service to the Society. It is our aim to continue to lead the field in pro-
viding Society members with disability protection and claim services as modern as tomor-
row.

SPECIAL FEATURES ARE:

1. Up to a possible 7 years for each sickness (no confinement required).

2. Pays up to Lifetime for accident.

3. New Maximum limit of $650.00 per month income while disabled.

All new applicants, and those now insured, who are under age 55, and in good
health, are eligible to apply for the new and extensive protection against sickness and ac-
cident.

OPTIONAL HOSPITAL COVERAGE: Members under age 60 in good health may apply for
$20.00 daily hospital benefit — Premium $20.00 semi-annually.

Write, or call us collect (Durham 2-5497) for assistance or information.

BENEFITS AND RATES AVAILABLE UNDER NEW PLAN

COST UNTIL AGE 35 COST FOR AGES 35 TO

Accidental Death 'Dismemberment

Coverage Loss of Sight, Speech Accident and Annual Semi-Annual Annual Semi-Annua

or Hearing Sickness Benefits Premium Premium Premium Premium

5,000 5,000 to 10,000 50.00 Weekly $ 78.00 $ 39.50 $104.00 $ 52.50

5,000 7,500 to 15,000 75.00 Weekly 114.00 57.50 152.00 76.50

5,000 10,000 to 20,000 100.00 Weekly 150.00 75.50 200.00 100.50

5,000 12,500 to 25,000 125.00 Weekly 186.00 93.50 248.00 124.50

5,000 15,000 to 30,000 150.00 Weekly 222.00 111.50 296.00 148.50

'Amount payable depends upon the nature of the loss as set forth in the policy.

Administered by
J. L. CRUMPTON, State Mgr.
Professional Group Disability Division
Box 147, Durham, N. C.

J. Slade Crumpton, Field Representative
UNDERWRITTEN BY THE COMMERCIAL INSURANCE COMPANY OF NEWARK, N. J.

Originator and pioneer in professional group disability plans.

November, 1960

HEALTH AND ADJUSTMENT OF THE AGED— BUSSE

507

lion elderly people are now confined to hos-
pitals. Although the age group over 65 com-
prises only 8 per cent of the population, it
uses 18 per cent of the general hospital beds
and 80 to 90 per cent of the nursing home
beds.

The National Health Survey made in 1957
revealed a definite relation between age and
the amount of time spent in bed or lost from
work because of either acute or chronic dis-
orders. A "restricted activity day" was de-
fined as a day in which the customary activ-
ities were restricted for the entire day be-
cause of illness. A person was considered
to have a day of "bed disability" if he spent
all or most of the day in bed because of ill-
ness or injury. A day spent in the hospital
was counted as a day of bed disability,
whether or not the individual was confined
to bed. The survey revealed that the annual
number of days of both restricted activity
and bed disability increased progressively
with age (table 1).

Age
Group

25-44
45-64
65 plus

Table 1

Average Number of Days Lost Per Year
Restricted Activity Bed Disability

14.2 4.6

21.1 6.4

44.4

15.4

According to the same National Health
Survey, the incidence of acute, disabling
conditions declines throughout life, while
the number of chronic diseases steadily in-
creases. Consequently, there is an increas-
ing need for medical facilities to care for the
chronically ill, long-term patient, who does
not require the expensive diagnostic and
therapeutic equipment nor the intensive
nursing services and specialized knowledge
found in the general hospital. It is extremely
important that steps be taken to fill the gap
between the home and the general hospital
by providing facilities for convalescent or
chronically ill patients.

The Cost of Illness in Our Aging
Population

The cost of illness among our aging pop-
ulation, both from the individual's viewpoint
and from society's viewpoint, is nothing
short of frightening. When I employ the
word cost, I am not only referring to the
financial cost, but am also thinking in terms
of individual happiness and loss of social
functions which in my opinion are equally
crucial to the maintenance of our democratic
way of life.

Report No. 20 of the United States De-
partment of Health, Education, and Wel-
fare, dealing with health costs of the aged,
gives factual data that document the mag-
nitude of the loss produced by illness in our
aging population. In 1951 a nationwide sur-
vey of beneficiaries of old-age and survivors
insurance disclosed that 31 per cent of all
the beneficiaries surveyed were confined to
bed by illness at some time during the year
covered by the survey. Forty per cent of
these patients spent more than four weeks
in bed, either at home or in a general hos-
pital or some other type of institution. Three
and a half per cent of all the beneficiaries
covered by the survey were completely bed-
ridden, and one in seven required consider-
able assistance from others.

In Rhode Island a study was made of el-
derly citizens who were living outside of
institutions. Forty-six per cent reported
themselves as either being in poor health or
having serious physical handicaps.

Health Insurance and the Problem
of Motivation

In view of the high incidence of disease
and disability in our elderly citizens, it is
not surprising that the question of federal
health insurance for the aged is one of the
most vital social and political issues facing
the United States today. In speeches and
articles concerned with health insurance for
elderly people, the words "comprehensive,"
"adequate," and "minimum" are used with-
out clarification. The interpretations given
such words may have considerable political
value, but are not necessarily consistent with
the actual medical-social situation. The two
words comprehensive and adequate have a
reassuring quality, but defining them is dif-
ficult. An "adequate" program of health in-
surance, for instance, can be interpreted to
mean sufficient funds to cover the cost of all
required medical care, or merely to help
meet the cost of such care. An additional
complication is the fact that medical costs
are not consistent throughout the United
States, and that the climate and living con-
ditions frequently affect the decision for
hospitalization, which increases the cost.

"Adequate" can also be used to imply a
standard of medical care. Lack of manpow-
er, facilities, and funds makes it impossible
to provide the very best medical care for all
our citizens. Clearly, "adequate" medical

508

XORTH CAROLINA MEDICAL JOURNAL

November, 1900

care means less than the very best — but how
much less?

The other word, comprehensive, recurs in
all discussions regarding health insurance
plans; but if we are to adopt the World
Health Organization's definition of health —
"a state of complete physical, mental, and
social well-being and not merely the absence
of disease or infirmity" — where does a com-
prehensive program of health insurance ter-
minate?

Because of these difficulties in denning
words, some people have learned to speak
with caution. For example, Senator Mc-
Namara of the Senate Subcommittee on the
Problems of the Aged and the Aging has
said, "A program of comprehensive health
insurance is required to meet the minimum
health needs of the retired aged." The word
minimum has a warning quality, but it is
a more realistic word than comprehensive or
adequate. Much effort has gone into at-
tempts to define a minimum health program,
but these attempts are frustrated by our
lack of actual knowledge. Until we know
what is really needed, it would be foolish
and expensive to commit ourselves firmly to
a rigid, long-term program of health insur-
ance.

I wish to emphasize one basic factor which
must be considered in the treatment of any
illness, and is of utmost importance in the
care of patients with chronic diseases. This
basic factor is motivation — the desire within
the individual to overcome his pain, limita-
tions, and disabilities, in order to return to
or achieve a position of personal and social
independence.

Motivation is both a conscious and an un-
conscious psychologic phenomenon. Para-
doxically, motivation that is consciously ex-
pressed can be in direct opposition to what
is going on in the unconscious. Motivation

is affected by certain forces within the indi-
vidual and in the environment — forces that
are bound to physical and personal needs, as
well as to gains and losses. These gains and
losses are related not only to the physical
status of the individual, but also to his en-
vironmental and social circumstances — in-
cluding, of course, his financial situation.
In our society the striving for financial se-
curity and the attitudes which it develops
form a part of motivation, and as such can
affect the duration of hospitalization, enthu-
siasm for rehabilitation, length of convales-
cence, and request for medical care. All too
often the desire for financial security can
interfere with the incentive to get well.
When illness provides a secure, dependent
relationship, it is very hard for some indi-
viduals to work actively toward an inde-
pendent existence.

From a medical standpoint this social at-
titude is unfortunate, but it must be faced.
The experience of the Veterans Administra-
tion has clearly demonstrated that free med-
ical care and disability pensions seriously
interfere with motivation and prevent many
patients from achieving a state of maximal
functioning. Apparently for political rea-
sons, very little has been done to educate
the public concerning this situation, or to
alter the situation itself.

Any plan to provide for the medical needs
of the aged should take into consideration
not only the most efficient methods of col-
lecting and distributing funds, but also the
importance of maintaining motivation. Fis-
cal policies should be secondary to this con-
sideration. A program that interferes with
motivation will prevent the health profes-
sions from achieving the goal we all wish
to reach — better health for our elderly cit-
izens. If we can achieve this goal, we will
have a stronger nation.

Experience in the management of these patients who have success-
fully passed through an attack of cardiac infarction endorses the view
that it should become a recognized procedure to direct the patient back
to his work after he has rested for a month and convalesced for a sec-
ond month. That no undue risks are incurred from the adoption of this
practice has been proved by inquiry about the physical activities engaged
in at the time of the initial attack or subsequent ones. In the great ma-
jority of cases the illness set in either at rest or while undergoing ha-
bitual easy exercise, and only exceptionally during unaccustomed heavy
exertion. — Evans, W. : Faults in Diagnosis and Management of Cardiac
Pain, Brit. M.J. 1:253 (Jan. 31) 1959.

November, 1960

509

Experiences in a Glaucoma Detection Clinic

Charles W. Tillett, M.D.
Charlotte

The purpose of this presentation is to re-
late the experiences of 10 ophthalmologists*
in Charlotte in setting up a glaucoma detec-
tion clinic.

Glaucoma is the leading cause of irre-
versible blindness in adults in this country.
Surveys have shown approximately 2 out of
every 100 individuals over the age of 39
have the disease.

In its early stages, when it is most sus-
ceptible to treatment, the symptoms are
few or non-existent. In its advanced stages,
when the visual difficulties are all too prom-
inent, treatment can only halt the progress
of the disease. No known method of therapy
can restore vision or visual field lost as a
result of the increased intra-ocular pres-
sure and its consequent damage to the op-
tic nerve. It is thus extremely important
to detect the disease early.

The starting point is in the physician's
office. The use of routine tonometry in all
patients over the age of 35 has become
standard practice with the majority of
ophthalmologists. But some patients are
slow to seek eye care and some are treated
by non-medical refractionists. These pa-
tients may acquire the' disease undetected,
reaching the ophthalmologist after the loss
of vision has set in.

A glaucoma detection clinic focuses pub-
lic attention on this important disease and
permits the screening of a large number
of individuals. Adequate publicity is an im-
portant factor in the success of such a clin-
ic. The local medical society can help by
such means as informative articles in the
newspapers, small posters in drug stores,
and spot announcements on radio and tele-
vision. There is available from the Nation-
al Society for the Prevention of Blindness
an excellent 20-minute film on glaucoma,
"Hold Back the Night", which can be
shown to civic groups. Emphasis is placed
on individuals 40 years of age and older,
and those with a family history of this con-
dition.

♦Participating: eye physicians were Drs. Reed Gaskin,
Thomas D. Ghent. Walter Graham. M. J. Hougrh, Ruth Leon-
ard, Marvin Lymberis, Henry Sloan, Jr., David Stratum. Jack
Thurmond, and Charles Tillett.

The physical location of such a clinic is
of some importance. It is desirable to have
at least two examining tables and reason-
ably large waiting room facilities so that a
large number of patients can be seen.
Where a number of individual ophthalmol-
ogists are practicing in a community, it is
desirable to locate the clinic where it is not
specifically identified with any individual or
group. Charlotte eye physicians have been
fortunate in having available the facilities
of the emergency outpatient clinic at the
Mercy Hospital. More recently the city-
county health department building has been
utilized.

Personnel is another important factor in
the success of such a clinic. Our medical aux-
iliary has been of considerable help in the
registration of patients, preparing small
5x7 inch cards for each patient's name,
age, and address. The National Society for
the Prevention of Blindness has chapters
in a number of communities throughout
the state, and their assistance has been in-
valuable in operating our clinic and in
follow-up services. The health department,
which has been most cooperative, has pro-
vided the services of two nurses at all
times. The nurses helped the patients dur-
ing the examination onto the examining
table and down again and instilled ponto-
caine eye drops, thus enabling us to see
many more patients than otherwise would
have been possible.

The examination itself consisted of
measuring the tension in each eye with a
tonometer and in performing an ophthal-
moscopic examination. Any patient with a
tension of 24 mm. of mercury or higher was
advised to see an ophthalmologist, as were
patients in whom ophthalmoscopic examin-
ation revealed abnormal cupping of the op-
tic nerve even though the tension was
normal. Other patients, found to have cat-
aracts, macular disease, retinopathy, or
other eye diseases, were likewise advised to
see a specialist.

The manner of scheduling a glaucoma
detection clinic has varied in different parts
of the country. In some communities the
clinic has been held during one full day. In

-,lll

NORTH CAROLINA MEDICAL JOURNAL

November, 1960

others, various industrial plants have been
screened. Our particular clinic was held for
a full week, with hours from 9:00 a.m. to
5:00 P.M. Monday through Friday. Each of
the participating physicians contributed at
least half a day, and many contributed
additional Hme when the case load required
it. With the help of the nurses and others
it was possibb for one examiner to see as
many as 30 to 40 patients an hour at peak
hours. On a few occasions when the case
load was greater than could be handled,
ophthalmoscopic examination was omitted
and 60 or more patients per hour were seen
per examiner.

Results

Clinics have been held in three successive
years. Seven hundred patients were screened
in the first year and 800 in the second.
This number increased to 3,000 in 1959.
The patients were predominantly in the 40
or older age group.

In the first two years 4 per cent of the
patients had an elevated tension. Statistics
on the most recent clinic (1959) indicate
that 4.5 per cent of the patients (135 out of
3,000) had an elevated tension. Although
follow-up data are not complete, it is esti-
mated that half of these patients proved to
have glaucoma. Clinics of this type else-
where in this country have had similar re-
sults.

Sum mary

1. A week-long glaucoma detection clinic
has been held three successive years
by ten eye physicians in Charlotte.

2. The total number of individuals
screened increased from 700 in 1957
to 3000 in 1959. These patients were
predominantly over the age of 39.

3. Approximately 4 per cent of patients
tested showed an elevated intra-ocular
tension. It is estimated that half of
these, or 2 per cent of the total, proved
to have glaucoma.

SPECIAL REPORT

ANALYSIS, REVIEW, AND

EVALUATION OF CLINICAL PRACTICE

IN THE HOSPITAL

RESPONSIBILITY

Only physicians are capable of judging
what is or what is not good medical practice.
Patients and hospital personnel may learn
to recognize good practice, but only the phy-
sician can accurately evaluate its quality.

The opinions of individual physicians vary
and rightly so. For that reason, the Com-
mission places heavy emphasis on group
participation in evaluating clinical practice.
It is the responsibility of the entire Active
Medical Staff to analyze, review, and eval-
uate the clinical practice in the hospital and
to insist on high standards of performance
from each of its members.

This responsibility is not easily dis-
charged. It requires hours of work which
the busy physician can ill afford to spend
and which is usually done at the expense of
his personal pleasures. It requires an ob-
jectivity which is perhaps even more diffi-
cult to achieve. To judge the work of a col-
league on a fair, unbiased, impartial level
calls for the intelligence and wisdom of a
Solomon. That this is so well done in thou-
sands of hospitals can be attributed to the
integrity, effort, and persistence of each
member of the medical staff.

ESSENTIALS

In order to evaluate clinical practice the fol-
lowing are essential :
1 — Reliable Medical Records

There must be evidence on the medical
record that the diagnosis was made on
the basis of information given by the pa-
tient in the history, a careful physical
examination, and a scientific interpreta-
tion of the findings. There must be suf-
ficient data recorded to justify the phy-
sician's treatment of the patient and the
results. For the sake of both the group
whose responsibility it is to review the
record and the physician whose perform-
ance is being evaluated, a good medical
record is indispensable.
2 — Reliable Reports of Diagnostic Tests
The physician must rely on the accuracy
of reports on laboratory and diagnostic
tests. The medical staff cannot supervise
all these areas, but it has a responsibil-
ity to make certain that there is super-
vision. This is done by recommending the
appointment of qualified individuals to
head these departments and to designate
those on the staff qualified to interpret
electrocardiograms, x-rays, and other
diagnostic tests. If laboratory work is
done outside the hospital, it must be
made certain that these laboratories are
government approved, licensed, and un-
der the direct supervision of a patholo-
gist.

November, 1960

EDITORALS

511

3 — An Organized Medical Staff

To insure a continual orderly process of
evaluating clinical practice the medical
staff must be formally organized. This
provides a framework in which duties
and functions of the staff can be carried
out. The medical staff may decide to del-
egate the responsibility of clinical re-
view to committees, to clinical depart-
ments, or to the staff as a whole. Only
the individual medical staff can deter-
mine the method which will be most ef-
fective in the local situation.

4 — A Competent Medical Staff

Though listed fourth, the most impor-
tant factor in evaluating clinical prac-
tice is a competent medical staff. The
quality of medical care in the hospital
is in direct ratio to the knowledge, ex-
perience, and ability of the members of
the medical staff. The judgment neces-
sary to evaluate clinical practice depends
entirely on the ability of those who are
doing the evaluating.
This makes the appointment to the staff
and the delineation of privileges so im-
portant. To do this fairly and objective-
ly, the medical staff should set up a sys-
tem to evaluate each applicant and deter-
mine his hospital privileges on the basis
of professional competence. Individual
character, training, experience, and abil-
ity should be criteria for selection. Un-
der no circumstances should the accord-
ance of staff membership or professional
privileges in the hospital be dependent
solely upon certification, fellowship or
membership in a specialty body or so-
ciety. Neither should appointments be
denied on the basis of hospital bed ca-
pacity or selfish competitive motives on
the part of the staff.

Although the primary purpose of clinical
review is to achieve and maintain high
standards of patient care, the process
also serves as a means of evaluating the
performance of individual staff members.
The judgment, ability, and competence
of a staff member can be assessed by his
methods of diagnosis, his skill in treat-
ment, and his ability to recognize situa-
tions which call for consultation. These
facts should influence the decision to ex-
tend or limit his hospital privileges.
Each member of the staff should be given
the opportunity to realize his full capa-

bilities, and at the same time safeguards
must be established to protect patients.
By good clinical review both patient and
and staff member profit.
The Commission in accrediting a hospital
places great emphasis on the extent and care
with which the medical staff reviews and
evaluates clinical practice. Since good med-
ical records, reliable diagnostic services, and
a competent, well organized staff are essen-
tial for good clinical review, these factors
are closely surveyed. To be accredited, there
must be evidence that the hospital medical
staff is living up to its important responsi-
bilities.

/s/ Kenneth B. Babcock, M.D.
Director

Joint Commission on
Accreditation of Hospitals

TJhe Bmke Umiversitv

Jay M. Arena, M.D., Director
Durham
KEROSENE, GASOLINE, AND
PETROLEUM DISTILLATES
Kerosene, together with other petroleum
products, accounted for more than 100
deaths in 1949-50, a fourth of all fatal poi-
sonings among children under 5 years of age
in the United States. Of 252 children ad-
mitted to Charity Hospital in New Orleans
over a 10-year period for kerosene poisoning
— the commonest cause of poisoning among
admissions — 9 died. The incidence of poison-
ing from petroleum products, principally
kerosene, in 12 Southern states is four times
greater than that in other areas. In the
South kerosene is extensively used for cur-
ing tobacco, heating, cooking, and, in more
remote areas, for lighting. This product is
often removed from its original container
and put into an empty cola bottle, which is
often carelessly left about where toddlers do
not hesitate to sample it.

Signs and Symptoms
Hydrocarbon ingestion causes symptoms
in two organs systems: the central nervous
system and the lungs. In addition, it has a
direct irritative action on the pharynx, eso-
phagus, stomach, and small intestine, with
edema and mucosal ulceration. Depression
of the central nervous system occurs soon

512

NORTH CAROLINA MEDICAL JOURNAL

November, 19(30

after ingestion, followed by severe pneu-
monitis in a few minutes to several hours.
Death, when it occurs, is from pulmonary
insufficiency, not the depression of the cen-
tral nervous system. Histopathologic exam-
ination of the lungs shows primarily a se-
vere necrotizing pneumonia. If the patient
recovers, no late sequelae are seen. The great
seriousness of kerosene poisoning, therefore,
lies in the pulmonary damage.

How this damage comes about as a result
of swallowing even a small amount of the
liquid has been the subject of controversy.
One explanation is that the child aspirates
some kerosene either directly or in the
course of vomiting or gastric lavage An op-
posing idea is that kerosene is absorbed
from the gut and excreted by way of the
lung — but this theory has the defect that
kerosene placed in the stomach of experi-
mental animals fails to produce any striking
pulmonary injury. Richardson showed that
in rabbits 0.25 ml. of kerosene per kilogram
of body weight could cause fatal pneumonia
when injected directly into the trachea.
Thirty milliliters per kilogram was neces-
sary to produce the same effect when in-
stilled by nasograstric tube into the stomach,
and since the rabbit does not vomit, it was
assumed that the hydrocarbon must reach
the lung via the blood stream. If these
values can be applied to children, a child
weighing 10 Kg. would have to ingest 12
ounces of hydrocarbon to produce a fatal
pneumonia if no aspiration occurred, where-
as only 2.5 ml. could prove fatal with aspira-
tion.

The clinical picture produced by kerosene
is quite variable. Symptoms appear early
and consist predominantly of either cerebral
depressive effects or respiratory manifesta-
tions or, in some children, both at once.

The child may be found coughing and
choking, and with the odor of kerosene on
the breath or clothing. If some time has
elapsed following ingestion, he may be drow-
sy, stuporous or in frank coma. In one
series, 6 of 101 patients were found uncon-
scious; about 50 children had vomited. Fever
(sometimes high), tachycardia, and tachyp-
nea develop in most patients. Signs of pul-
monary involvement include dyspnea and
cyanosis, with rales, rhonchi, dullness and
diminished breath sounds at one or both
lung bases. Following massive aspiration,
pulmonary edema may be marked, and is

usually the cause of death. Most patients are
acutely ill, but those with slight pulmonary
manifestations often recover in 24 to 48
hours. Those with combined cerebral and
pulmonary involvement are more acutely ill,
and it is among these that cardiac dilata-
tion, transient hepatosplenome^a'y and ab-
normal urinary findings are found.

Roentgenographs changes can be seen
within an hour or two of ingestion. At first
there are multiple, small, patchy densities
with ill defined margins; in more advanced
cases the lesions become larger and tend to
coalesce. Emphysema may develop. Pneu-
mothorax occasionally occurs. The maximum
changes are noted in two to eijht hours af-
ter ingestion. Among patients who survive,
resolution is gradual, the lungs clearing in
three to five days, with radiologic sir ns lag-
ging behind the clinical improvement.

Treatment

Treatment of kerosene poisoning is non-
specific and symptomatic. One or two ounces
of mineral or vegetable oil by mouth (if not
forced) would tend to prevent the absorp-
tion of kerosene as well as hurry it through
the intestinal tract, In the presence of pul-
monary signs, oxygen is the "most valuable
agent" to relieve respiratory distress and
anoxia. Antibiotics should be administered
in therapeutic doses to forestall secondary
pulmonary invaders, even in the absence of
overt pulmonary signs and symptoms, since
pulmonary involvement can occur without
clinical signs. The use of steroids as an anti-
inflammatory agent in the treatment of ne-
crotizing pneumonitis has proven to be very
effective, and should be used for any severe-
ly ill and toxic patient. Appropriate therapy
is indicated for fluid and electrolyte imbal-
ance. Attempts to keep stuporous children
awake by exercise have no rational basis.

On the basis of Richardson's experiments
(see under Signs and Symptoms), as well as
of clinical studies suggesting a more severe
pneumonia in patients who had spontaneous
or induced vomiting with this type of poison-
ing, it would appear that treatment without
lavage or emesis is preferable. Lavage, if
used, however, should be done with extreme
care. The head and chest should be lowered,
copious amounts of water or a 3 per cent
solution of sodium bicarbonate or normal
saline should be used and the tube pinched
off and quickly withdrawn.

November, 1960

EDITORALS

513

North Carolina Medical Journal

Owned and published by

The Medical Society of the State of North Carolina,

under the direction of its Editorial Board.

EDITORIAL BOARD
Wingate M. Johnson, M.D., Winston-Salem

Editor
Miss Louise MacMillan, Winston-Salem

Assistant Editor
Mr. James T. Barnes, Raleigh

Business Manager
Ernest W. Furgurson, M.D., Plymouth
John Borden Graham, M.D., Chapel Hill
G. Westbrook Murphy, M.D., Asheville
William M. Nicholson, M.D., Durham
Robert W. Prichard, M.D., Winston-Salem
Charles W. Styron, M.D., Raleigh

Address manuscripts and communications regarding
editorial matter to the
NORTH CAROLINA MEDICAL JOURNAL
300 South Hawthorne Road, Winston-Salem 7. N. <'
Questions relating to subscription rates, advertis-
ing, ect., should be addressed to the Bu=ine=»
Manager, 203 Capital Club Building. Raleigh. N. C
All advertisements are accepted subject to the ap-
proval of a screening committee of the Statp
Journal Advertising Bureau, 510 North Dearborn
Street, Chicago 10, Illinois, and /or by a Committep
of the Editorial Board of the North Carolina Medi-
cal Journal in respect to strictly local advertising
accepted for appearance in the North Carolina
Medical Journal.

Annual subscription, $5.00 Single copies, 75<*

Publication office: Carmichael Printing Co., 1309

Hawthorne Road, S.W., Winston-Salem 1, N. C.

November, 1960

FALL MEETING OF THE
EXECUTIVE COUNCIL

The regular fall meeting of the Executive
Council of the State Medical Society was
held on Sunday, October 2 — at the end of a
three-day conclave of committees — at the
Mid Pines Club at Southern Pines. A tre-
mendous amount of work was accomplished
in these three days. The long agenda of the
Executive Council concluded with reports of
the six commissions, which largely consti-
tutes the summary of membership work and
effort of the Society. Most of the committee
work was summarized by the chairmen of
the commissions in their reports. A few of
the more important committee reports were
given by the chairmen of the respective com-
mittees, in order to lend emphasis and de-
tail to the subject matter involved and
studied.

The conclave and Executive Council meet-
ing were well attended. President Amos
Johnson was an admirable presiding officer,
guiding the discussion skillfully through a

long agenda and the handling of the diffi-
cult questions which arose.

A matter of greatest interest was the sub-
ject of a report of the reactivated committee
to study the question of scientific member-
ship, of which Dr. Street Brewer is chair-
man. The Council unanimously adopted the
committee's recommendation re-affirming the
Society's stand on scientific membership as
now expressed in its Constitution and By-
laws, and adopted a motion that the Meck-
lenburg County Medical Society be asked to
clarify its position on membership for Ne-
gro physicians. Another motion was also
passed that the President, the Secretary,
and Mr. John Anderson prepare a form to
be used in applying for membership in the
Society. It is proposed that applications
should read something like this: / hereby

apply for a membership in the

Medical Society of the State of North Caro-
lina. The blank would be filled in by one of
two terms specified by our Constitution (Ar-
ticle IV, section 1) — Active or Scientific.

Drs. Paul Whitaker and Ben Royal, who
were on the original committee with Dr.
Brewer, corroborated his statement that the
Negro medical leaders who met with their
committees five years ago had broken faith
with the committee, for they had agreed that
the proposed scientific membership was all
that they could and did ask for, and that
they were well satisfied with it in their pro-
posals. Only two Negro physicians, however,
have applied for this membership, and they
were both formally castigated by members
of the Old North State Medical Society.

Dr. Wayne Benton, chairman of the Com-
mittee on Finance, reported that the Society
now had a $96,000 surplus and that invest-
ments had paid 5 per cent during the past
year. So many life members had asked for
refunds of their dues that the committee
recommended that all who had been listed as
life members have their dues refunded. A
number of the Executive Council members,
however, stated that they did not wish their
dues to be refunded — so a motion was passed
allowing all life members the privilege of
paying dues so long as they wished. Dr. Ben-
ton reported that the Building Committee
was still functioning.

Both the Committee on Legislation and
Chronic Illness recommended that steps be
taken as soon as possible for North Caro-

514

NORTH CAROLINA MEDICAL JOURNAL

November, l'JGO

lina to take advantage of the provisions of
the Mills Act to provide medical care for its
older citizens. A resolution to that effect was
passed unanimously, copies of which are to
be sent with accompanying letters to Gov-
ernor Hodges and Dr. Ellen Winston, Com-
missioner of Welfare.

Dr. Jacob Shuford, chairman of the Com-
mittee on Blue Shield, reported that this
committee had approved the Hospital Care
Association, as well as the Hospital Saving
Association, to sell Blue Shield Insurance,
but that the National Blue Shield did not
approve Hospital Care Association for Blue
Shield, because they thought Blue Shield
should be managed by a single agency in a
given territory or jurisdiction — not overlap-
ping. This committee recommended, there-
fore, that a corporation of the Medical So-
ciety be created to coordinate the efforts of
the Hospital Care Association and the Hos-
pital Saving Association, and to control the
Blue Shield insurance. The motion was
passed unanimously.

Dr. W. A. Sikes, superintendent of the
State Hospital in Raleigh, said that some
doctors had been too lax in meeting require-
ments of the law in committing patients to
the State Hospital. Although the law states
plainly that the doctor shall examine the
patient before commitment, some have been
prone to sign papers without an examina-
tion. Others have been admitted under class-
ification as drug addicts rather than alco-
holics, because the drug addict may be kept
in the hospital 60 days, the alcoholic only 30.
Still another error of omission was to have
the patient admitted as an emergency with-
out an examination. Many of these technical
violations may result in liability actions
later on.

Dr. Oscar E. Goodwin of Apex was elected
to fill Dr. Earl Brian's unexpired term as a
member of the State Board of Health, ter-
minating in June 1963.

Two medical district councilor vacancies
occurred as the result of Dr. Claude Squire's
election as president-elect and of the resig-
nation of Dr. Merle D. Bonner of the Eighth
District. Dr. Bonner had insisted that his
resignation be accepted. These vacancies
were quickly filled by promoting the vice-
councilors — Dr. Edwin Bivens of Albemarle
for the Seventh and Dr. Harry Johnson of
Elkin for the Eighth.

Mrs. J. M. Hitch, president of the State
Women's Auxiliary, was in Chicago for a
meeting, and her husband read her excellent
report to the Council, reviewing the activ-
ities of the Auxiliary this year. The Aux-
iliary has taken an active part in emphasiz-
ing the American Medical Education Foun-
dation. In this effort the ladies are promot-
ing the sale of Christmas cards. They have
been disappointed at the response so far —
and hope that their husbands will join them
in pushing the sale of these cards. All the
profit goes to the A.M.E.F.

The final action of the Council was an
evaluation of the conclave method of co-
ordinating activities of the various commit-
tees. All present agreed that it was the most
satisfactory and efficient method and recom-
mended that it be continued, with the pro-
vision that the Executive Secretary and the
President-elect be empowered to select meet-
ing places for the Fall Conclave and the
Officers' Conference in time to secure suit-
able accommodations.

AUXILIARY CHRISTMAS CARDS

The Woman's Auxiliary of the State Med-
ical Society has long been interested in the
American Medical Education Foundation.
This year the Auxiliary has undertaken the
ambitious project of selling Christmas cards
as a means of raising money for this worthy
cause. Mrs. Loftin H. Harris, chairman of
the A.M.E.F. committee, has a goodly sup-
ply of these Hallmark cards on hand, to be
sold to Auxiliary members for $2.25 per box
of 25 cards, and resold for $3.50 per box, or
14 cents a card. The profit is to go to the
A.M.E.F.

The cards are really good looking. Two
pine cones tied with red ribbon are on the
front. On the inside is the traditional "Mer-
ry Christmas and Happy New Year" oppo-
site the legend, in small letters, "This card
has been selected in the interest of the
American Medical Education Foundation."
They compare favorably with others that are
purely commercial.

The Auxiliary invested a good deal of
money in this venture. Since Christmas
cards are a necessity at this time of the year,
let all good doctor-husbands come to the aid
of their wives, and boost the sale of the
A.M.E.F. cards.

November, 1960

EDITORALS

515

INFLUENZA IMMUNIZATION URGED

Since the devastating 1918-19 pandemic
of influenza there have been annual epi-
demics of gradually decreasing severity. In
1957-58, however, the so-called Asian strain
of influenza was more severe and caused
many more deaths than had been the case
for a number of years. Surgeon General
Burney appointed an Advisory Committee on
Influenza Research. This committee found
that the lack of resistance and its wide-
spread occurrence caused the high mortal-
ity, especially in the chronically ill. the aged,
and in pregnant women. As a result of these
findings, the Public Health Service is urging
a continuous program of immunizing the
high-risk groups routinely. The Public
Health Service lists the high-risk groups as
follows :

1. Persons of all ages who suffer from chronic de-
bilitating disease, in particular: (a) rheumatic
heart disease, especially mitral stenosis; (b) other
cardiovascular diseases, such as arteriosclerotic
heart disease or hypertension — especially patients
with evidence of frank or incipient insufficiency; (c)
chronic bronchopulmonary disease, for example,
chronic asthma, chronic bronchitis, bronchiectasis,
pulmonary fibrosis, pulmonary emphysema, or pul-
monary tuberculosis; (d) diabetes mellitus; (e)
Addison's disease.

Lilly, Lederle, Merck, Sharpe, and Dohme,
National Drug Company, Parke - Davis,
Charles Pfizer, and Pitman-Moore.

2. Pregnant women.

3. All persons 65 years or older.

The vaccine advised is polyvalent and the
dosage recommended is 1.0 cc. subcutaneous-
ly, repeated after an interval of two months
or longer. Many doctors prefer a two-week
interval, but the committee has given much
thought to the longer interval between doses.
The committee adds, "Preferably the first
dose would be given no later than September
1 and the second before November 1." Un-
fortunately, the statement was not received
in this office until the last of October. It is
never too late to do good, however, and the
conscientious family doctor should urge his
high-risk patients to be immunized as soon
as possible. Persons previously immunized
with polyvalent vaccine should get a single
booster dose each fall — prior to November 1.

Those of us who remember the terrific toll
taken by the 1918 epidemic can appreciate
the importance of immunization.

The following pharmaceutical houses are
licensed manufacturers of influenza vaccine :

DR. JOHN E. DONLEY

The Rhode Island Medical Journal reports with
sorrow the death, on September 17, 1960, of Dr.
John E. Donley, distinguished Editor-in-Chief of
the Journal, a past President of the Rhode Island
Medical Society, and the only Rhode Island re-
cipient of the Dr. Charles Value Chapin Award
of the City of Providence.

The Journal also announces that the House of
Delegates — assembled in meeting on September
28, 1960, elected Dr. Seebert J. Goldowsky as the
new Editor-in-Chief of the Rhode Island Medical
Journal to succeed the late Doctor Donley. Doc-
tor Goldowsky has been an Associate Editor of
the Journal for many years.

John E. Farrell, Sc.D.
Managing Editor
Although Rhode Island is the smallest
state in the Union, its medical journal is one
of our favorite exchanges. It has consistent-
ly maintained a high standard of original
articles and of editorial content. Dr. Donley
was a worthy successor to the brilliant and
lovable Peter Pineo Chase, who died in
harness April 23, 1956. Now Dr. Goldowsky
has a large pair of editorial shoes to fill —
but no doubt will keep the Rhode Island
Medical Journal on the same high level as
his predecessors. He does not come as a nov-
ice, since for many years he has been an as-
sociate editor.

The North Carolina Medical Journal
extends to the Rhode Island Medical Society
sympathy in the loss of Dr. Donley, and con-
gratulations on having a capable successor
in Dr. Goldowsky.

YALE SCHOOL OF MEDICINE
CELEBRATES SESQUECENTENNIAL

ANNIVERSARY
The September issue of Connecticut Medi-
cine is devoted to the sesquecentennial anni-
versary of the Yale University School of
Medicine. The celebration is to be held Oc-
tober 28-29. The entire issue of the Septem-
ber Connecticut Medicine contains a number
of articles dealing with this great school.

The North Carolina Medical Journal
takes great pleasure hi congratulating both
the school of medicine and the medical jour-
nal— and wishes for both the best of every-
thing in the years to come.

5 Hi

NORTH CAROLINA MEDICAL JOURNAL

November, 1960

President's Message

Where Does Charity Stop ?

Recently, your State Medical Society,
through the unanimous action of its execu-
tive Council, adopted the principle of coop-
eration with *tate and federal governmental
agencies to provide medical care for our in-
digent and "medically indigent" citizens in
the 65 and over age group. This was deemed
proper and is in keeping with policies ad-
vanced by the American Medical Associa-
tion. Copies of the adopted resolutions were
sent to Governor Hodges, Commissioner of
Public Welfare, Dr. Ellen Winston, and
other state agencies urging the immediate
and total implementation of this Federal
legislative action.

The Committee on Chronic Illness, John
R. Kernodle, M.D., chairman, is charged
with liaison with governmental agencies
dealing specifically with implementing this
legislation. The Committee Advisory to the
North Carolina State Board of Public Wel-
fare, J. Street Brewer, M.D., chairman, as
in all matters pertaining to medicine and
welfare, will also act in advisory capacity
in this proposition.

Presently, North Carolina is not imple-
mented and participant in this federal pro-
gram. Parts of the program we may partici-
pate in without additional state legislation;
other and important facets of participation
will require new local state legislation. Al-
ready, 5 of our 50 states are total partici-
pants. Following action by your Executive
Council, the State Medical Society has of-
fered full cooperation and support to Gov-
ernor Hodges and to Commissioner Winston
in getting this project immediately under
way.

Recently, in discussions between Commis-
sioner Winston and Dr. Kernodle pertinent
to this assistance program, a matter of vital
importance to all North Carolina doctors
was unearthed. This I shall attempt to pre-
sent to you clearly.

Bluntly, but factually, this issue is — Shall
medical services furnished in this state in
compliance with the federal legislation be
furnished by us "for free," or, shall we re-
ceive reasonable payment for services ren-
dered these patients, as a service of the fed-
eral and state government, on a vendor pay-

ment basis as provided for in this legisla-
tion?

Commissioner Winston has given thought
to this proposition. I quote from Dr. Ker-
nodle's report of his conference with Com-
missioner Winston

She asked whether the doctors were going to
change their idea of accepting payment for in-
digent patients and whether vendor payment
schedules should be set up for the doctors. She
inquired on the point that doctors had, in the
past, offered and likewise had given their services
free for all indigent patients. — She then stated
that she would hope we would not (request pay-
ment) but if we did, she felt that we should also
set up a scale for the OAA group.
Now, we are at the crux of this problem.
Policies which we set here will be vital to
medicine in North Carolina in years to come.
The pattern we cut in this instance will be
used to "size" us in each instance as this
program is inevitably expanded.

As Dr. Winston recognized above, "Doc-
tors had in the past offered and likewise had
given their services free for all indigent pa-
tients." This is true and, I believe, will re-
main true so long as the charitable care of
these indigent patients remains in its tradi-
tional and proper perspective. That is, that
they are, in sequence, a responsibility of
their family, their community, and then
their local governmental agencies. This is an
instance of "From him who has, according
to ability — to him who has not, according to
need." This constitutes basic charity and is
good. Under these circumstances we will
give amply of our basic commodity, medical
care, and of ourselves as a charitable service
to our fellow man.

When the responsibility for medical care,
among other responsibilities, of the indigent
and "medically indigent" is assumed by
agencies of the state and federal govern-
ments, then the proposition of charity alters
its position. These people then become the
wards, proportionally equally, of all those
who are taxed to support government. To
the proposition, "From him who has, accord-
ing to ability — to him who has not, accord-
ing to need," now add, "by force," and you
see this is no longer charity. This is com-
patible with the Marxist theory of commun-
ism.

November, 1960

BULLETIN BOARD

517

As doctors, we are required to pay our
proportionate share of taxes just as are all
others who earn by their efforts or ingen-
uity. A proportionate share of the money
appropriated to finance this welfare legisla-
tion, which in itself asks for no charity, thus
was exacted from us as doctors. Therefore,
logic should hold that purveyors of medical
services should be compensated for their
services commensurate with all other par-
ticipant in such a program.

I would like for every member of our
Medical Society to be aware that shortly,
within weeks, policy must be established
which will be the pattern, for years to come,
of remuneration for medical services ren-
dered the wards of government by you as
doctors. Dr. John R. Kernodle of Burlington
and Dr. J. Street Brewer of Roseboro will
be high among those who will make this de-
cision for you. Those of you who have in-
terest in the present and future of medicine
and your Medical Society should feel free
to communicate your thoughts and ideas
concerning this matter to either Dr. Ker-
nodle or Dr. Brewer.

Amos N. Johnson, M.D.

BULLETIN BOARD

COMING MEETINGS

Duke University Medical Center, Lectures on
Ophthalmology — Eye Clinic, Duke Hospital, Tues-
day evenings, 7:30 p.m.

American College of Physicians, Regional Meet-
ing— Duke University Medical Center, Durham, De-
cember 1.

North Carolina Health Council, Annual Meeting —
N. C. State College Union, Raleigh, December 7.

University of North Carolina School of Medicine,
Postgraduate Sessions in Pediatrics, Ophthalmology,
Medicine, Surgery, Obstetrics and Gynecology —
Edenton, Wednesdays, beginning January 11; Kin-
ston, Thursdays, beginning- January 12.

Governor's Conference on Occupational Health —
Raleigh, January 26, 1961.

North Carolina Mental Health Association — Sir
Walter Hotel, Raleigh, February 17-18.

Emory University Postgraduate Course in Oph-
thalmic Surgery — Grady Memorial Hospital, Atlan-
ta, December 1-2.

Postgraduate Conference on Pediatric Urological
Problems, sponsored by the University of Virginia
School of Medicine — Charlottesville, December 2.

Southern Surgical Association, Annual Meeting —
Boca Raton, Florida, December 3-8.

Gill Memorial Eye, Ear and Throat Hospital,
Thirty-fourth Annual Spring Congress — Roanoke,
Virginia, April 10-15, 1961.

New Members of the State Society

The following physicians joined the Medical
Society of the State of North Carolina during the
month of October:

Dr. Robert Lowell Dame, 214 Ridgeway Avenue,
Statesville; Dr. Pleasant Paul Deaton, Broughton
Hospital, Morganton; Dr. Dockery Durham Lewis,
Jr., 942 Davie Avenue, Statesville; Dr. Albeit Hop-
kins Fink, Banner Elk; Dr. John Ashley Goree, Duke
University Medical Center, Durham; Dr. E. Carwile
LeRoy, 106 Fort Washington Avenue, New York 32,
N. Y.

News Notes from the
Duke University Medical Center

Plans for a multi-million dollar clinical research
program that will be a major development at the
Duke University Medical Center have been an-
nounced by Dr. Deryl Hart, president of the Uni-
versity.

Total cost of the project during its five years of
operation will be approximately $3,111,000.

This includes U. S. Public Health Service funds
expected to total $1,581,000 for support of the pro-
gram during its first five years. Facilities will be
housed in a new Medical Center addition that will
cost an additional $1,530,000 provided by the Public
Health Service and private sources.

Explaining the purpose of the undertaking, Duke
Medical School Dean Barnes Woodhall said that
clinical research is concerned with "the careful
study of what takes place in various disease states"
and with "precise evaluation of the effectiveness
of new drugs and treatment methods."

Dean Woodhall said that the program was or-
ganized under the direction of Dr. Frank L. Engel,
professor of medicine, who will continue to serve as
its head until the appointment of a permanent di-
rector and an associate director next year.

Duke is one of 11 institutions over the nation
selected by the Public Health Service for establish-
ment of clinical research centers. Another is the
University of North Carolina.

A symposium on Malignant Disease with four
noted cancer authorities as guest speakers was held
at the Duke University Medical Center on October
28.

Co-sponsoring the symposium with the Duke
Medical Center was the Durham County unit of the
American Cancer Society.

Speakers were Dr. J. A. del Regato, director of
Penrose Cancer Hospital, Colorado Springs, Colo-
rado; Dr. Lee Clark, Jr., director and surgeon-in-
chief of M.D. Anderson Hospital, Houston, Texas;
Dr. Lauren V. Ackerman, professor of surgical
pathology at the Washington University School of
Medicine, St. Louis, Missouri ; and Dr. John V.
Blady, clinical professor of surgery and director
of the tumor clinic at the Temple University Medi-
cal Center, Philadelphia, Pennsylvania.

518

NORTH CAROLINA MEDICAL JOURNAL

November, 11)00

Three new faculty members have been appointed
in the Biochemistry Department of Duke Univer-
sity Medical Center. Dr. R. Taylor Cole, Provost
of the University, announced recently.

Dr. Charles Tanford has joined the faculty as
professor of physical biochemistry; Dr. Ralph E.
Thiers as associate professor of biochemistry and
associate director of Duke Hospital's clinical chem-
istry laboratory; and Dr. Walter R. Guild as as-
sociate professor of biophysics.

The promotion of Dr. Robert W. Wheat from
associate in biochemistry to assistant in biochemis-
try to assistant professor of biochemistry also was
announced.

George B. Kantner has been appointed personnel
director at the Duke University Medical Center,
hospital superintendent Charles H. Frenzel an-
nounced recently. He will be responsible for ad-
ministration of personnel policies, recruitment, and
screening of job applicants and development of im-
proved personnel programs for the Medical School.
* * *

Dr. John E. Dees, professor of urology at the
Duke University Medical Center, was elected presi-
dent of the North Carolina Urological Association
during the Associations 1960 meeting held in
Roaring Gap. He will hold office for two years,
succeeding Dr. Oliver J. Hart of Winston-Salem.

Other new officers are vice-president, Dr. Bruce
Langdon of Fayetteville; and secretary-treasurer:
Dr. Jack Hughes of Durham.

A Duke University chemist, Dr. Peter Smith, has
joined the ranks of scientists engaged in research
which may help lessen the damaging effects of
radioactive materials on human beings.

Dr. Smith work for the three-year period end-
ing on September 30, 1963, will be supported by a
$62,030 financial commitment from the National
Institutes of Health Service.

News Notes from the University of
North Carolina School of Medicine

A new method for "seeing" and studying the
human spleen, developed at the University of North
Carolina School of Medicine, was described this
month in Atlantic City at the 61st annual meet-
ing of the American Roentgen Ray Society.

The scientific presentation was made by Dr.
Philip M. Johnson, who was a faculty member of
the UNC School of Medicine up to the time -of his
resignation last month. The co-scientists on the
project were Dr. Ernest H. Wood, professor of
radiology, and Dr. Stewart L. Mooring, assistant
in radiology, both of the UNC School of Medicine.

This work was carried out in Dr. Johnson's lab-
oratory at the UNC School of Medicine and was
supported by a grant from the U. S. Public Health
Service.

An FM radio device which broadcasts the heart-
beat of patients — and has been used in dozens of
instances at N. C. Memorial Hospital has won first
prize in a national medical exhibition in New York.

Faculty members of the School of Medicine put
on display at the annual meeting of the American
Society of Anesthesiologists a frequency modula-
tion broadcasting technique designed at the medical
school in Chapel Hill. It is a recent adaptation of
widely employed principles of radio telemetry to
use in the operating room.

A description of the technique whereby a patient
broadcasts his own heart signals from the operating
table is described in a report entitled "Radio Tele-
metry in Physiological Monitoring" by Drs. David
A. Davis, Doris C. Grosskreutz, Kenneth Sugioka
and Mr. William Thornton. The application of
radio telemetry for this purpose has been developed
within the past year.

Two associate professors of surgery at the Uni-
versity of North Carolina School of Medicine parti-
cipated at the annual meeting of the American
College of Surgeons at San Francisco recently.

Dr. C. G. Thomas, Jr., presided at the forum ses-
sion of the 1960 Clinical Congress at A.C.S. meeting.

Dr. Erie E. Peacock read a paper on "The Effects
of Some Rate Regularity on the Synthesis of Col-
lagan in Healing Wounds."

A one-day seminar for physicians on the pre-
vention and management of athletic injuries was
held at the University of North Carolina School of
Medicine Wednesday, Sept. 21. Some 100 doctors,
most of them physicians for football teams attended.
* * *

Eight faculty members of the University of North
Carolina School of Medicine participated in the
annual meeting of the Southern Medical Association
in St. Louis, October 31-November 3.

A meeting of the U.N.C. Medical Alumni As-
sociation was held in connection with the Associa-
tion's meeting. The speakers at the alumni meeting
were Dr. John T. Sessions, Jr., UNC associate pro-
fessor of medicine, and Dr. John S. Rhodes, presi-
dent of the Medical Alumni Association. Dr. Joseph
M. Hitch of Raleigh, UNC clinical professor of
medicine, presided at the alumni session.

The faculty members who took part in the scienti-
fic sessions of the medical meeting were Dr. Ses-
sions; Dr. A. Stark Wolkoff, assistant professor of
obstetrics and gynecology; Dr. Robert A. Ross, pro-
fessor and head of the Department of Obstetrics
and Gynecology; Dr. Samuel D. McPherson, Jr.,
clinical professor of surgery (ophthalmology) ; Dr.
H. Robert Brashear, Jr., associate professor of
surgery (orthopedics) ; Dr. Robert D. Langdell, as-
sociate professor of pathology and U. S. Public
Health Service Senior Research Fellow, and Dr.
Robert A. Gregg, clinical associate professor of
preventive medicine.

November, 1960

BULLETIN BOARD

519

A two-day program on cystic fibrosis was held in
the Clinic Auditorium of the University of North
Carolina School of Medicine on Thursday-Friday,
Oct. 20-21.

Presented for doctors, nurses and physical thera-
pists, the program was sponsored by UNC Section
of Physical Therapy in cooperation with the De-
partment of Pediatrics and the Department of
Medicine.

* * *

The annual University of North Carolina School
of Medicine Symposium was held at N. C. Memorial
Hospital Thursday and Friday, November 17-18.
The subject for the symposium was Gastroenter-
ology.

The guest participants on the program were Dr.
Eddy D. Palmer, lieutenant colonel, Brooke General
Hospital, Fort Sam Houston, Texas; Dr. Edward
E. Owen, associate in medicine, and Dr. Malcolm
P. Tyor, associate professor of medicine, both of
Duke University School of Medicine, and Dr. David
Cayer, clinical professor of medicine, Bowman Gray
School of Medicine.

News Notes from the Bowman Gray
School of Medicine

Dr. Chauncey G. Bly has been appointed re-
search professor of pathology at Bowman Gray
School of Medicine of Wake Forest College. His
appointment was effective September 1. College of-
ficials said Dr. Bly will conduct various teaching
and research programs within the department. He
received his Ph. D. and M.D. degrees from the Uni-
versity of Rochester and the University of Rochester
School of Medicine, Rochester, New York, and was
previously associated with the Department of Path-
ology at Duke University Medical Center.

Dr. Warren N. Dannenburg has also joined the
faculty as research assistant professor of biochemis-
try. He received his M.S. and Ph. D. degrees at
Texas A. and M. College. His research activities
will be in collaboration with the department of
obstetrics and gynecology.

Other faculty appointments include Dr. Robert J.
Faulconer as lecturer in the history of medicine;
Dr. Ivan L. Holleman as instructor in pathology;
Dr. Hugh L. Moffet as instructor in pediatrics
(Dr. Moffett is also a National Institutes of Health
fellow in virology and infectious diseases) ; Dr.
Charles L. Moore as instructor in surgery; Drs.
Frank E. Pollock and James E. Robinson as as-
sistants in clinical orthopedics ; Dr. Nancy O'Neil
Whitley as assistant in preventive medicine; Dr.
Thomas B. Templeton as assistant in internal medi-
cine; Dr. Robert P. Thomas as instructor in opthal-
mology; and Dr. Howard S. Wainer as assistant
in clinical internal medicine.
* * *

An informative medico-legal program was pre-
sented Friday, November 4, at the Bowman Gray

School of Medicine's clinical amphitheater as a part
of the school's annual Alumni Day activities.

James Sizemore, professor of law at the Wake
Forest College School of Law and lecturer in medi-
cal jurisprudence at Bowman Gray School of Medi-
cine, spoke on "The Doctor as an Expert Witness."
Okla W. Johnson of Greensboro, agent in charge of
the U. S. Treasury Department's North Carolina
and western Virginia narcotics division, presented
a film entitled "Medical Hazards" and spoke on
"Narcotics Addiction." And. William J. McAuliffe.
Jr. of Chicp°'o. I'linois. an attorney with the lesral
division of the American Medical Association, dis-
cussed "M"lnractic° Protection."

Robert F. Clodfelter. a trust officer at Wachovia
Bank and Trust Co., Winston-Salem, spo'-e on
estate planning at the banquet session at the For=vth
Countrv Club. Medic' school Dean C. C. Carnenter
and Dr. D. E. Ward. Jr. of Lumberton. president
of the Medical Alumni Association, also participated
in the banquet program.

* * *

Dr. Howard H. Bradshaw. professor and chair-
man of the department of surgery, has been named
to the National Institutes of Health's Clinical Re-
search Fellowships Review Panel for a four-year
term.

The NIH fellowship program provides individual
support for training in the basic and clinical sciences
in medical and allied fields. Its purpose is to develop

more teachers and investigators for medical schools.

* * *

Dr. Norman M. Sulkin. William Neal Reynolds
Professor of Anatomy and chairman of the denart-
ment. has been named to a sub-committee of the
North Carolina Governor's Coordinating Committee
on Aging. The subcommittee will inventory current
research in gerontology in North Carolina.

This project was recommended bv a recent Snecia-
lized Study Committee on Research and Population
which prepared material for the North Carolina

Governor's Conference on Aging last July.

* * *

Dr. Richard C. Proctor, chairman of the depart-
ment of psychiatry, was re-elected secretary-trea-
surer of the Southern Psychiatric Association. Octo-
ber 4. at Virginia Beach. Virginia. Psychiatrists in
13 southern states compose the association.

Mr. Clvde T. Hardy, Jr., director of the depart-
ment of clinics, addressed a meeting of the Associa-
tion of American Medical Colleges, October 31. at
Hollywood Beach, Florida. His topic was "Clinical
Faculties and Medical Service Plans."

Coming Academic Events

December 12, 7:30 p.m., clinical amphitheater:
Committee on Medical Education program with Dr.
Stephen Abrahamson, professor of education at the
University of Buffalo School of Education, Buffalo,
New York, speaking on "Evaluation of Teaching
Programs."

520

NORTH CAROLINA MEDICAL JOURNAL

November, 1960

Watts Hospital Symposium

The eighteenth annual Watts Hospital Sym-
posium will be held in Durham, February 3 and 4.
The following- speakers will participate: Drs. Fred-
erick W. Goodrich, Jr., John R. Haserick, William
D. Holden, Oscar B. Hunter, Jr., William K. Keller,
Rachmiel Levine, R. Bruce Logue, Alton Ochsner,
Edward H. Rynearson, Paul A. Younge, and Col.
John P. Stapp, USAF, MC.

A complimentary barbecue dinner will be served
early for those desiring- to attend the Carolina-
Duke basketball game Saturday night. A limited
number of reserved seats at $2.50 are available.
Those desiring- tickets should inform Dr. G. W.
Crane, 1200 Broad Street, Durham by November 1.

North Carolina Hospitals
Board of Control

In accord with the need for postgraduate train-
ing' for physicians in psychiatry, the North Caro-
lina State Hospitals are attempting' to measure the
interest of non-psychiatrists in participating in
training' and research in psychiatry which is going
on in these various hospitals. Accredited programs
are to be established according to demand and de-
g'ree of support, federal and state. Interested phy-
sicians may contact Dr. Charles Vernon, Director
of Professional Training, North Carolina Hospitals
Board of Control. Box 70, Raleigh, North Carolina.

Central Carolina Rehabilitation
Hospital

What, one community is doing in rehabilitation
of patients suffering from chronic disease or im-
pairments was outlined by Dr. Robert A. Gregg,
Greensboro, North Carolina, in an address at the
Fifty-fourth Annual Meeting of the Southern Medi-
cal Association in St. Louis, October 31-November
3.

Speaking before the Section on Physical Medicine
and Rehabilitation, Dr. Gregg discussed problems
facing Guilford County, North Carolina, in provid-
ing adequate care for the long-term patient, and
the progress that has been made during the past
two years.

He detailed how a group of interested citizens
formed a rehabilitation committee, assisted in the
conversion of a former poliomyelitis hospital into
a rehabilitation center at Greensboro, and saw their
efforts culminate in the opening of the Central
Carolina Rehabilitation Hospital, offering a medi-
cal department with a wide variety of equipment
and personnel to assist the chronically disabled
patient to return to his fullest functional capacity.
Services at the hospital include medical, psychologic
social, and vocational.

Financial assistance has been obtained from the
Office of Vocational Rehabilitation under Public
Law 565 to assist in operating costs for the first
fiscal year.

Dr. Gregg says that a close liaison has been
maintained between the Guilford County Medical

Society and the rehabilitation hospital. The staff
at present consists of a full-time medical director
and an active courtesy staff of physicians from
all specialties. The hospital is a non-profit one,
governed by a nine-member Board of Trustees and
medically supervised by a five-member Board of
Physicians.

Robeson County Medical Society

The Robeson County Medical Society held its
regular monthly meeting on October 3, at Lumber-
ton.

Dr. Nathan Womack, professor of surgery, Uni-
versity of North Carolina Medical School, was
speaker for an afternoon clinical session and an eve-
ning lecture. In the clinical session he discussed
cholelithiasis and cancer of the breast. In the eve-
ning he presented a paper entitled "Massive Hemor-
rhage In Cirrhosis."

The program was sponsored by Lippincott's Medi-
cal Science.

Edgecombe-Nash Medical Society

The monthly meeting of the Edgecombe-Nash
Medical Society was held October 12, in Rocky
Mount.

Dr. B. M. Gold, program chairman for October,
presented as guest speaker, Dr. John Arnold of the
Pediatrics Department, Memorial Hospital, Chapel
Hill, whose topic was "Differential Diagnosis of
Polio and Viral Diseases of Childhood."

News Notes

Drs. Wilmer C. Betts, J. Douglas McRce. and
Barbara M. Moore of Raleigh announce the associa-
tion of Robert N. Harper for the practice of child
and adult psychiatry. Offices are located at 2109
Clark Avenue, Cameron Village.

* * *

Dr. Robert T. Savage has reopened his office for
general practice and pediatrics at 1020 Stratford
Road, Winston-Salem.

* * *

Dr. Sherwood W. Barefoot has announced the
association of Dr. John H. Cox in the practice of
dermatology, with offices located at 108 East North-
wood Street in Greensboro. Dr. Cox was certified
by the American Board of Dermatology and Syphi-
logy in 1953.

Gill Memorial Eye, Ear and
Throat Hospital

The Gill Memorial Eye, Ear and Throat Hospital,
Roanoke, Virginia, will hold its thirty-fourth an-
nual Spring Congress in Ophthalmology and Oto-
laryngology and Allied Specialties April 10
through April 15, 1961.

There will be 20 guest speakers and 50 lectures.

November, 1960

BULLETIN BOARD

521

American College of Surgeons

Approximately 1,175 surgeons were inducted as
new Fellows of the American College of Surgeons
at the annual five-day Clinical Congress of the
College.

Fellowship is awarded to doctors who fulfill com-
prehensive requirements for acceptable medical
education and advanced training as specialists in
one or another of the branches of surgery, and who
give evidence of good moral character and ethical
practice.

Those receiving this distinction from the State
of North Carolina at the Convocation are as
follows: Drs. Jack Powell, Asheville; John E. Way.
Beaufort; Donald W. Robinson, Captain, USN,
Camp Lejeune; Benjamin H. Flowe and Edwin M.
Tomlin, Concord; Victor A. Politano and W. Glenn
Young, Jr., Durham; Crowell T. Daniel, Jr., Fayet-
teville; M. Harvey Rubin, Greensboro; W. Grime-
Byerly, Jr., Hickory; Frederick P. Dale, Kinston;
John C. Lawrence, Lumberton; Duwayne D. Gadd.
Pinehurst; Warren J. Collins, Shelby; J. Ralph
Dunn, Jr., Tarboro; and Jesse H. Meredith, Wins-
ton-Salem.

American Medical Association

A symposium on Clinical Nutrition will be held
in Washington, D. C. on November 30. This sym-
posium, sponsored by the Council on Foods and
Nutrition of the American Medical Association in
cooperation with the Medical Society of the District
of Columbia, will begin at 8:30 a.m. Wednesday,
November 30, in Room B of the National Guard
Armory. The meeting will be opened to all inter-
ested persons.

The National Foundation

The National Foundation announced recently the
publication of a new monthly annotated biblio-
graphy on arthritis and related diseases. It is being
sent initially to 3,650 selected individuals and insti-
tutions all over the world.

The bibliography will cover scientific articles on
arthritis appearing in professional journals both
here and abroad. Entitled "Current Literature —
Arthritis and Related Diseases," it is designed to
serve as a comprehensive and up-to-date reference
to the vast international literature on rheumatic
diseases.

The present plan calls for the distribution to
departments of internal medicine, pediatrics, and
microbiology of all medical schools in this country,
to medical libraries here and pbroad, to occupational
and physical therapy schools, collegiate nursing
schools, grantees and medical advisers of The
National Foundation, a selected group in national,
state and local government health agencies, mem-
bers of the American Rheumatism Association, and
certain medical journals and individuals.

American Board of
Obstetrics and Gynecology

The Part 1 examinations (written) will be held
in various cities of the United States, Canada, and
military centers outside the Continental United
States on Friday, January 13, 1961.

Reopened candidates will be required to submit
case reports for review 30 days after notification
of eligibility. No reopened candidate may take the
written examination unless the case abstracts have
been received in the office of the executive secre-
tary.

Current Bulletins outlining present requirements
may be obtained by writing to Executive Secretary,
Robert L. Fa'ulkner, M.D., American Board of
Obstetrics and Gynecology, 2105 Adelbert Road,
Cleveland 6, Ohio.

World Medical Association

At its fourteenth General Assembly held in West
Berlin, Germany, September 15-22, the World Medi-
cal Association elected the following officers:
president — Dr. Paul Eckel, Germany; president-
elect— Dr. Antonio Moniz, Brazil; Council members
— Drs. J. G. Hunter, Australia; L. W. Larson, U. S.
A.; Antonio Spinelli, Italy; Hector Rodriguez,
Chili.

Dr. Heinz Lord was elected secretary-general,
and Dr. Gunnar Gundersen was elected chairman
of the Council. Dr. Larson is chairman of the
Committee on Medical Education.

U. S. Department of
Health, Education and Welfare

Competitive Examinations for appointment of
physicians as Medical Officers in the Regular Corps
of the United States Public Health Service Com-
missioned Corps will be held throughout the United
States on January 31, and February 1 and 2, 1961.

Application forms may be obtained by writing to
the Surgeon General, United States Public Health
Service (P), Washington 25, D. C. Completed ap-
plication forms must be received no later than
December 2, 1960.

* * *

The cooperation of physicians is requested in a
study on the association of polycythemia with neo-
plastic disease being conducted by the metabolism
service of the National Cancer Institute in the
Clinical Center of the National Institutes of Health.
An elevation of the circulating red cell volume in
the absence of leucocytosis and thrombocytosis has
been noted in a significant number of patients with
renal tumors and cerebellar hemangioblastomas and
rarely in patients with uterine fibroids, pheochromo-
cytomas, and other neoplasms. The presence of an
erythropoiesis stimulating factor has been demon-
strated in homogenates of the cerebellar, renal,
and pheochromocytoma tumor tissue. This study
has as its purpose the determination of the chemi-

522

NORTH CAROLINA MEDICAL JOURNAL

November, 1960

cal and mode of action of the erythropoiesis stimu-
lating' factor produced by these tumors.

Patients admitted to the study undergo a period
of clinical evaluation including the determination
of the circulating- red cell volume, red cell life span
and the rate of red cell synthesis. Plasma and tumor
tissue, if available, will be assayed for erythropoie-
sis stimulating activity.

Physicians who wish to have their patients con-
sidered for this study at the National Cancer Insti-
tute may write or call: Dr. Thomas A. Waldmann,
National Cancer Institute, Bethesda 14, Maryland.

Physicians and workers in allied fields who are
interested in the venereal diseases are invited to
participate in the twelfth annual Venereal Disease
Symposium at the Hotel New Yorker in New York
City April 1.3 and 14, 1961.

The program committee for the 1961 symposium
points out that reported cases of primary and
secondary syphilis have increased 52 per cent over
the past year.

Sponsored jointly by the American Venereal Dis-
ease Association and the Public Health Service,
the symposium will follow a Seminar on Venereal
Disease for public health personnel which begins
April 10.

Compliments of

WachtePs, Inc*

SURGICAL
SUPPLIES

15 Victoria Road

ASHEVILLE, North Carolina

P. O. Box 1716 Telephone AL 3-7616

Veterans Administration

An electronic flash system that provides light
for photographing the interior of the human eye-
ball— and quickly enough to give a minimum of
discomfort to the patient — has been developed by a
Veterans Administration medical illustrator.

He is Leonard M. Hart of the Durham, North
Carolina, VA hospital's medical illustration division.

Hart's lighting system can be used on a standard
retinal camera.

He has been developing the electronic flash for
about five years. He devised the lighting system
while he was employed at the VA's West Side Hospi-
tal in Chicago and perfected it at the Durham VA
hospital, where he is working in conjunction with
Dr. Albert Heyman of Duke Hospital.

The electronic flash is used for only one-thouandth
of a second, and focusing is done by use of a milder
repetitive flashing light.

Dr. Heyman uses the photographs to study blood
vessels inside the eyeball, as an aid to diagnosis of
abnormalities in blood vessels of the brain and for
research about strokes.

Hart described his new electronic flash system at
a recent meeting of the Biological Photographic-
Association, in Salt Lake City.

Appointment of Dr. Robert I. McClaughry of
the National Academy of Sciences-National Re-
search Council as director of medical education
service for the Veterans Administration was an-
nounced by the VA today.

A former assistant dean of Wayne University's
College of Medicine in Detroit, Dr. McClaughry has
been associated in a professional capacity with the
Division of Medical Sciences of the National Acad-
emy of Sciences in Washington, D. C, since June
1958.

Appointment of Joe Meyer, Ph.D., as chief of
the medical research laboratories division of the
Veterans Administration was announced by the VA
recently.

Dr. Meyer has been serving as chief of the medi-
cal research laboratories of the Houston, Texas,
VA hospital and associate professor of biochemis-
try at Baylor LTniversity College of Medicine, since
1959.

New Medical Film Released

The release of a new medical film, "The Mech-
anism and Control of Nausea and Vomiting," was
announced recently by Smith Kline & French Lab-
oratories.

Jack C. Borland, director of SK&F's Medical
Film Center, said the 21-minute, color film is "based
on the findings over the past 10 years on the neuro-
logical mechanisms involved in nausea and vomit-
ing." It is available on a free-loan basis to pro-

November, 1960

BULLETIN BOARD

523

fessional audiences through local representatives of
the Philadelphia pharmaceutical firm.

Prints of the new film also may be obtained
through the Medical Film Center, Smith Kline &
French Laboratories, Philadelphia 1, Pa.

Griseofulvin Effective in Treatment of Bursitis

Effective treatment of bursitis, pain from "whip-
lash" injuries to the neck, and the shoulder-hand
syndrome by the administration of griseofulvin was
reported by Dr. Howard Rusk in the August 14 is-
sue of the New York Times.

In an earlier report, published in the June 4 is-
sue of the Journal of the American Medical Asso-
ciation, Drs. Abraham Cohen, Richard Daniels, and
William Kanenson, all of Philadelphia, and Dr. Joel
Goldman of Johnstown, Pennsylvania, told of their
successful use of griseofulvin in the treatment of
shoulder-hand syndrome.

Operating on the theory that the antibiotic could
be used as an anti-inflammatory agent, the physi-
cians administered Fulvicin (griseofulvin) to pa-
tients suffering from rheumatoid arthritis, includ-
ing 12 patients with shoulder-hand syndrome, a dis-
ease affecting the nerves and circulation. No effect
was noted in relieving the pain or other symptoms
of the arthritis. However, good results were ob-
served in those patients with shoulder-hand syn-
drome.

Dr. Rusk noted that "this is far too small a group
from which to draw firm and permanent conclu-
sions, but the improvement was so prompt and last-
ing that it seemed significant."

Dr. Cohen and his associates stated that "we are
unable to give a scientific explanation of our find-
ings. The consistency with which the improvement
occurs is indeed unusual. This is a preliminary re-
port, made in the hope that others might use this
method either to confirm or refute our findings."

Griseofulvin was introduced in this country as
Fulvicin by Schering Corporation in the fall of
1959.

"Prescription for Tomorrow"

One of the most fruitful efforts to bring the
achievements and the American health team — the
doctor, the druggist and the pharmaceutical manu-
facturer— to public attention reached a milestone
recently with the one thousandth presentation of
the speech "Prescription for Tomorrow."

The talk, which details the "medical revolution"
which has taken place during the last 30 years, is
the focal point of an ambitious speakers prog'ram
initiated by Smith Kline & French Laboratories,
Philadelphia drug firm, in June, 1959. Since that
time the speech has been heard by approximately
50,000 members of civic, fraternal and social groups
throughout 48 states and Canada.

In addition, it has carried to radio and television
audiences of more than 700,000.

The one thousandth presentation was made before
the Johnstown, Pennsylvania, Rotary Club by SK&F
Professional Service Representative James Blough,
one of more than 250 speakers trained under the
program.

Because of the success of this "grass roots" pro-
gram, the SK&F Speaker Bureau is currently en-
larging its scope to include talks on mental health
and the importance of quality control in pharmaceu-
tical manufacturing. Groups interested in securing
speakers for their gatherings may contact Dr.
Robert Haakenson, S.K. and F. Manager of Com-
munity Education for further information.

Classiified Advertisement

DESIRABLE LOCATION for a physician. Contact
Godley Realty Company, Mt. Holly Road, Char-
lotte, North Carolina.

Winston- Salem «

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MATERNAL DEATHS REPORTED IN NORTH CAROLINA^
SINCE JANUARY I, I960

Each dot represents one death

Wilmington-^,//

• •

524

NORTH CAROLINA MEDICAL JOURNAL

November, 1960

The Month in Washington

Representatives of the medical and health
professions the federal government and na-
tional civic groups are cooperating in de-
velopment of a program for starting the
general use of the Sabin live-virus poliomye-
litis vaccine next year.

Shortly after clearing the Sabin vaccine
for general use, Leroy E. Burney, M.D.,
Surgeon General of the Public Health Serv-
ice, asked 23 non-government organizations
to designate members to serve on a Surgeon
General's Committee on Poliomyelitis Con-
trol.

An Agenda Committee met with PHS
officials in Atlanta October 11 and 12 and
drafted a basic agenda for a meeting of the
Control committee in mid-winter. At the At-
lanta meeting, preliminary consideration
was given to administrative and technical
problems involved in use of the live-virus
vaccine developed by Albert B. Sabin, M.D.,
of Cincinnati.

The Agenda committee was made up of
representatives of the American Medical As-
sociation, American Academy of General
Practice, American Academy of Pediatrics,
Association of State and Territorial Health
Officers, Children's Bureau, and the National
Foundation.

The Sabin vaccine is not expected to be
available in substantial quantities before
mid-1961.

The chief question is whether the vaccine
— which is given orally in the form of pills,
liquid or candy — will be administered on in-
dividual or mass community basis. The PHS
special committee that recommended ap-
proval of the oral vaccine said that the com-
munity basis would be better.

"Because of the unique nature of live po-
liovirus vaccine, with its capacity to spread
the virus in a limited manner to non-vaccin-
ated persons, the committee cannot make
recommendations for manufacture without
expressing concern about the manner in
which it may be used," the special committee
said.

From Washington Office. American Medical Association, 1523
L Street. N.W.

"The seriousness of this responsibility can
be illustrated, for example, by the known
potentiality of reversion to virulence of live
poliovirus vaccine strains, and the possible
importance of this feature in the community
if the vaccine is improperly used.

"For example, the vaccine has been em-
ployed largely in mass administrations
where most of the susceptibles were simul-
taneously given the vaccine, thus permitting
little opportunity for serial human trans-
mission; or, it has been administered during
a season of the year when wild strains have
usually shown limited capacity for spread.
This experience should provide the basis for
developing useable practices for the U.S.A."

The special committee also said attention
should be given to administration to special
groups, such as very young children, preg-
nant women, and susceptible adults.

"Even more important is the planned con-
tinuation of this program as long as neces-
sary to achieve and maintain the required
results," the committee said.

The committee was headed by Roderick
Murray, M.D., of the National Institutes of
Health. Its other members were four M.D.'s
and one Ph.D., all of whom were connected
with universities except for one M.D. from
the PHS's Communicable Disease Center at
Atlanta.

Neither the committee nor Dr. Burney an-
ticipated that the live virus vaccine would
replace the killed-virus Salk vaccine used
since April, 1955.

"It appears probable that only a unified
national program which utilizes each of the
available types of vaccine to its best advan-
tage can accomplish the total prevention of
outbreaks," the committee said.

Dr. Julian P. Price of Florence, S. C,
chairman of the A.M.A.'s Board of Trustees,
predicted the live-virus vaccine "will be one
more powerful weapon against an ancient
and crippling disease." He said that physi-
cians "have conscientiously pushed immuni-
zation with the Salk vaccine and now, with
this new vaccine, the profession is hopeful
that even better results can be achieved."

Five states were ready soon after the ef-
fective date of October 1 to submit plans
for participation in the federal-state pro-
gram of health care for the needy and near-
needy aged persons which recently was en-
acted into law. The states were Arkansas.

November, 1960

BULLETIN BOARD

525

Michigan, New Mexico, Oklahoma, and
Washington.

As of early October, another 25 states
were preparing to consider legislation to
set up such a program or had indicated a
willingness to proceed without new legisla-
tion. They were Alabama, California, Colo-
rado, Delaware, Florida, Georgia, Hawaii,
Idaho, Illinois, Indiana. Kentucky, Louisi-
ana, Massachusetts, Montana, Nevada, New
Jersey, North Dakota, North Carolina, Ohio,
Pennsylvania, Rhode Island, Utah, West
Virginia, Virginia, and Wyoming.

Arthur S. Fleming, Secretary of Health,
Education and Welfare, urged all states to
take part in the program as soon as possible.
But he also said he hopes that Congress in
the next session will approve a Republican
plan for a supplementary federal-state pro-
gram to help provide private health insur-
ance for elderly persons who cannot meet
their medical expenses.

It appears that the issue probably will
arise in Congress next year because some
Democrats also have said they will again
sponsor legislation that would provide health
care for aged persons through the Social Se-
curity system.

The A.M. A. has launched a "comprehen-
sive study and action program" to guide
Americans in spending their health-care
dollars more wisely.

The A.M.A.'s new Commission on Medical
Care Costs has set out "to find answers to
the many questions being raised about med-
ical care costs and to present the findings
frankly and forthrightly to the medical pro-
fession and to the public."

The program is "dedicated to promoting
the highest quality health care at the lowest
cost." Louis M. Orr, M.D., of Orlando, Flori-
j da, chairman of the commission, said that
"any barrier that stands in the way of this
objective should be removed — immediately."

One of these barriers is money wasted on
ineffective non-prescription or over-the-coun-
ter drug products, such as vitamins, food
fads, and rheumatism and arthritis reme-
dies. A.M.A.'s Council on Foods and Nutri-
tion has estimated that much of the esti-
mated $350 million spent annually on
self-prescribed vitamins is wasted.

The A.M. A. is urging physicians to alert
their patients and the public to the latent
dangers involved in self-prescribing and to
the folly of throwing their health-care
dollars away on quackeries.

On another front in the war against
quackery, Food and Drug Commissioner
George P. Larrick reported that during the
past 12 months the FDA had seized falsely
promoted vitamins, minerals and other so-
called "health foods" valued in excess of
$1.5 million. He said that the amount of
misinformation, pseudo-science and plain
"hokum" on health care reaching the public
through books and magazine articles is in-
creasing.

iJtt iEpmnriam

Joseph Francis McGowan, M.D.

Dr. Joseph Francis McGowan, aged 57, died at
11:40 a.m., Sunday, July 17, in an Asheville hospi-
tal after a brief illness.

Dr. McGowan was the son of the late John and
Ann Burns McGowan of Cresson, Pennsylvania,
where he attended the public schools and St. Francis
College. His family then moved to Youngstown,
Ohio, where he attended the Youngstown College
and received his B.S. degree. He took his medical
course at the University of Maryland, graduating
in 1929.

After graduating in medicine Dr. McGowan re-
turned to Ohio and served an Internship at St.
Elizabeth Hospital Hospital in Youngstown, Ohio,
and engaged in general practice there for four years.
He then became interested in Eye, Ear, Nose and
Throat, and began the special studies in these
fields.

He took extensive post graduate courses in many
teaching centers including the University of Chi-
cago, Rush Medical College, University of Indiana
and North Western University. He served a term as
resident physician and surgeon at the Episcopal
E.E.N.T. Hospital in Washington, D. C, and then
further studied at Columbia University and N. Y.
Post Graduate Medical School.

Dr. McGowan came to Asheville in 1937 and be-
gan the practice of his specialty. He soon became
a member of the staffs of the Aston Park, Memorial
Mission, and St. Joseph's Hospitals. In the latter
hospital he served a term as chief of staff. During
the large practice of his specialty he was the author
of many articles which were published in medical
and scientific journals.

He was a past president of the Asheville Lions
Club, a member of St. Lawrence Catholic Church,
and the Fourth Degree Knights of Columbus, and
the Phi Chi Medical fraternity.

526

NORTH CAROLINA MEDICAL JOURNAL

November, lSMjO

How to Turn a 6°-° Raise
into a ^1,000 Bonus

WHAT SHOULD HE DO WITH AN EXTRA $5 A WEEK?
He can spend it, of course. But, if he
buys a $25.00 U.S. Savings Bond
each month for 40 months with his $5
a week raise, he is going to have
Bonds worth $1,000.

Wishing won't turn a $5 a
week raise into a $1,000
bonus, but it's easy to do. If
you take that $5 raise and
put it into U.S. Savings
Bonds you can buy a $25.00
Bond a month (cost $18.75)
and have money left over. If
you keep buying one of these
Bonds a month for 40 months
vou'll have your big bonus—
Bonds worth $1,000 at
maturity.

Why U.S. Savings Bonds are
such a good way to save

• You can save automatically
with the Payroll Savings Plan.

• You now earn 334' j interest
to maturity. • You invest with-
out risk under U.S. Govern-
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can't be lost or stolen. • You
can get your money, with in-
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• You save more than money;
you help your Government pay
for peace. • You can buy Bonds
where you work or bank.

Every Savings Bond you own — old or new — earns
XA % more than ever before when held to maturity.

You save more than money with U.S. Savings Bonds

«*«£

The U.S. Government does not pay for this advertising. The Treasury Department
thanks The Advertising Council and this magazine for their patriotic donation.

at

November, 1960

IN MEMORIAM

527

Dr. McGowan's interest in the activities and
scientific progress in medicine is shown by the
number of organizations to which he belonged.
Among these are: The North Carolina State Medical
Society, the North Carolina E.E.N.T. Society, the
Southern Medical Association, and the American
Medical Association. He was a Diplomate of the
American College of Allergists, and of the Ameri-
can Otorhinological Society for the advancement of
reconstructive plastic surgery. He was a Diplomate
of the American Board of Otolaryngology, a mem-
ber of the American College of Ophthamology and
Otolaryngology, and the New York Academy of
Science.

Surviving are the widow (the former Miss
Frances Genevieve Oddi). one son and four daugh-
ters of the home in Asheville, one brother Charles
McGowan of Pittsburg, Pennsylvania, and two sis-
ters, Mrs. Joseph Singer of Coraoplis, Pennsylvania,
and Mrs. Ben Conlin of Washington. D. C.

During the period of almost a quarter of a cen-
tury of practice in Asheville, Dr. McGowan proved
himself to be devoted to his family and actively
interested in the work of the church, the hospitals,
the medical societies, and the community at large.
One of his greatest hobbies was music.

His passing at the early age of 57 is a great loss
to the family, his friends, his patients and to the
community. He will continue to live in their memor-
ies.

Be it therefore resolved that the report of this
committee be adopted and entered into the minutes
of this Society; and that a copy be sent to the
family, to the North Carolina State Medical Society,
and to the A.M. A.

R. A. White, M.D.
W. M. Russell, M.D.
H. H. Briggs, M.D.

Adam Tredwell Thorp, M.D.

Dr. Adam Tredwell Thorp died at Park View
Hospital in Rocky Mount, on July 5, 1960, at the
age of 66. His death will be deeply felt by his
patients, friends, and professional colleagues
throughout the state.

He is survived by his wife, Mrs. Helen Merriam
Thorp of Rocky Mount; two sons, Dr. Adam T.
Thorp, Jr. of Bethesda, Maryland, and Dr. James
M. Thorp of Portsmouth, Virginia; and four grand-
children. He is also survived by two brothers, Mr.
Isaac D. Thorp of Rocky Mount and Mr. John Thorp

I of Wythville, Virginia.

Dr. Thorp was born in Nash County near Rocky
Mount in 1893. Following his early education in the
community schools he attended the University of
North Carolina, where he received his A.B. degree
in 1916. After teaching for a year in Goldsboro, he
! returned to the University of North Carolina where
he entered medical school. After completing the
two-year medical course there, he transferred to
the University of Pennsylvania where he received

li his M.D. degree in 1921.

After an internship at the Episcopal Hospital in
Philadelphia, Dr. Thorp returned to Rocky Mount
and began the practice of general medicine. He be-
came interested in obstetrics and gynecology and
in 1940, after doing post-graduate work, he re-
stricted his practice to that specialty. In addition
to his membership in the local, district, and state
medical societies, Dr. Thorp was a member of the
North Carolina Obstetrical and Gynecological
Society, which organization he served as president
in 1955, and of the South Atlantic Association of
Obstetricians and Gynecologists. He was a Fellow
in the American College of Obstetrics and Gyneco-
logy.

Dr. Thorp had many non-professional interests.
He was a life-long member of the Episcopal Church.
For many years he served as Director of the local
chapter of the Salvation Army and of the YMCA.
He maintained an active interest in the University
of North Carolina and particularly to The Medical
School and served as President of the Medical
Alumni and permanent class agent for his class of
1919.

Adam Thorp was a beloved man. He will be best
remembered for his endless expressions of thought-
fulness and kindness and for his gentle good humor.
His acts of kindness have made for many a road
less bumpy or a day more bright.

He loved the practice of medicine. He was one
of those few — those fortunate few — who early made
the complete self-surrender and thereafter wore
the iron yoke of duty — not complainingly — but joy-
ously.

He loved people, he loved his fellowman. And like
Abou Ben Adhem, we feel that he will be at the head
of the list of those whom the Lord loves.

He died after a massive myocardial infarction.
His manner of dying confirmed the axiom of the late
Sir William Osier: As a man lives so does he die.
Dr. Thorp died quietly, peacefully, a gentleman un-
afraid.

Therefore be it resolved, that we do mourn the
loss of our fellow-member of the Edgecombe-Nash
Medical Society, and that we extend our sympathy
and understanding to his widow, Helen Thorp, and,
that a copy of these resolutions be spread upon the
minutes of this Society and a copy be sent to Mrs.
Thorp and the North Carolina State Medical
Society.

C. T. Smith, M.D.

A. L. Daughtridge, M.D.

J. C. Brantley, Jr., M.D.

Earl \V. Brian, M.D.

Whereas, the death of Earl W. Brian, Raleigh
physician and a member of the State Board of
Health from July 15, to August 1, 1960, has brought
profound sorrow to his multitude of friends and
associates, and

Whereas, the State Board in recognition of his
influence and invaluable service wishing to express

528

NORTH CAROLINA MEDICAL JOURNAL

November, 1960

its sense of personal loss in his passing and its
grateful appreciation of his many virtues, does
hereby set forth this formal resolution of respect.

A native of Arkansas, Earl W. Brian received
his medical degree at Duke University in 1934 and
practiced medicine in Raleigh beginning in 1939. In
Raleigh he plunged into the professional and civic
life of the city and became active as a member of
the Edenton Street Methodist Church.

Elected to membership on the State Board of
Health in 1958 by action of the Medical Society of
the State of North Carolina, he brought to the
State Board a wealth of training and experience in
medical care, years of unselfish community services
— civic, church and preventive medicine, and above
all a devoted motivation and gentleness of spirit in
his every word and action. In his work on the State
Board he showed the same wisdom and conscientious
devotion to duty that he demonstrated in his pri-
vate life. His influence will be projected through
each of his co-workers in the State Board of Health
for a long time to come.

His deep interest in his fellow man and his acute
sense of duty were combined with his innate ability
in a way that brought him into places of principal
leadership in many phases of the community's life
— in the Wake County Medical Society, the Raleigh
Kiwanis Club, the Executives Club of Raleigh, the
United Fund of Raleigh, the Salvation Army, the
Occoneechee Boy Scout Council, the Wake County
Cancer Society, the Heart Association, the Wake
County Tuberculosis Association and in other or-
ganizations touching helpfully the health and wel-
fare of those about him.

Ever the epitome of a gentleman, an ardent
champion of the manly art of chivalric demeanor,
he moved among us with a quiet voice, a gentle
countenance, and a noble bearing that reflected and
bespoke the majestic character from which they
emanated. To know him was not only to love him
but also to join hands with him in living for others.
Be it therefore

Resolved, that this expression of respect and ap-
preciation be formally enacted by the State Board
of Health and spread upon its official minutes, and
that a copy be forwarded to the family of our de-
parted friend to convey, though inadequately, the
heartfelt sympathy of the members of the State
Board, and be it further

Resolved, that copies be also sent to the editor
of the North Carolina Medical Journal, the editor
of the Journal of the American Medical Associa-
tion, the editor of the Journal of the American
Public Health Association, the Secretary of the
Medical Society of the State of North Carolina, and
to the Secretary of the North Carolina Public
Health Association.

This sixth day of October, 1960.

BOOKS RECEIVED

Adventure to Motherhood: The Picture-Story of
Pregnancy and Childbirth. By J. Allan Offen, M.D.
Price, $2.95. Published by Audio Visual Education
Company of America, Inc. Distributed by Taplinger
Publishing Co., Inc., New York. 1960.

Your Child's Care. By Harry R. Litchfield, M.D.,
and Leon H. Dembro, M.D. 1001 Questions and
Answers. 257 pages. Price, $3.95. New York: Dou-
bleday & Company, 1960.

French's Index of Differential Diagnosis. Edited
by Arthur H. Outhwaite, M.D. Ed. 8. 1111 pages.
Price, $24.00. Baltimore: The Williams & Wilkins
Company, 1960.

Symposium of Pathology. By W. A. D. Anderson.
Ed. 5. 876 pages. Price, $9.25. St. Louis: The C. V.
Mosby Company, 1960.

Sight: A Handbook for Laymen. The Structure,
Functions, Malfuntions and Diseases of the Eye. By
Roy O. Scholtz, M.D. 166 pages. Price, $3.50. Gar-
den City, New York: Doubleday & Company, Inc.,
1960.

Nine Months' Reading: A Medical Guide for
Pregnant Women. By Robert E. Hall, M.D. 191
pages. Price, $2.95. Garden City, New York: Dou-
bleday & Company, Inc., 1960.

First Sustained-Action Oral Steroid
Is Developed by the Upjohn Company

The first sustained-action oral steroid drug — a
revolutionary new-type pellet form of Medrol has
been developed by The Upjohn Company. Initial
cilnical trials indicate better patient control with
smaller and less frequent doses can be achieved
with this new dosage form.

The preparation, called Medrol Medules, utilizes
a new kind of coating which permits substantially
reduced incidence of local side effects, especially
those related to gastric irritation.

SK&F Names New Director of Research
Dr. John Kapp Clark has been named director
of Research & Development at Smith Kline &
French Laboratories in Philadelphia.

Dr. Clark, who had been SK&F's director of Re-
search, succeeds W. Furness Thompson who has
resigned as vice president of Research & Develop-
ment. In addition to his new position with the
pharmaceutical firm, Dr. Clark will continue his
affiiliation with the University of Pennsylvania
where he serves as associate professor of medicine.

Last year, according to National Safety Council
statistics, some 9,300,000 citizens suffered fatal or
disabling injuries with approximately half of these
occurring in the supposed safe confines of the
home. In recent years, accidents have killed,
maimed and crippled more children between the
ages of 1 and 14 than the seven deadliest diseases
combined, and are now the leading cause of death
for all persons between the ages of 1 and 36.

November, 1960

ADVERTISEMENTS

XLI

IN EMOTIONALLY PROJECTED
SMOOTH -MUSCLE SPASM...

Prompt, Profound
Protection... at both

ends of the vagus

PRO-BANTHlNE*
,,„/, DARTAE

Professional reliance on the therapeutic profi-
ciency of Pro-Banthlne in functional gastro-
intestinal disorders has made it the most widely
prescribed anticholinergic.

The consistent relief of emotional tensions
afforded by Dartal makes this well-tolerated
tranquilizer a rational choice to support the
antispasmodic action of Pro-Banthlne in emo-
tionally influenced smooth-muscle spasm.

These two reliable agents combined as Pro-
BanthTne with Dartal consistently control both
disturbed mood and disordered motility when
emotional disturbances project themselves
through the vagus to provoke such gastrointes-
tinal dysfunctions as gastritis, pylorospasm,
peptic ulcer, spastic colon or biliary dyskinesia.

USUAL ADULT DOSAGE:

One tablet three times a day.

supplied as aqua-colored, compression-coated tab-
lets containing 15 mg. of Pro-Banthlne (brand of pro-
pantheline bromide) and 5 mg. of Dartal (brand of
thiopropazate dihydrochloride).

e.D.SEARLE&co.

Chicago SO, Illinois
Research in the Service of Medicine

in infectious disease""-
in arthritis "•'
in hepatic disease---'
in malabsorption syndrome1
in degenerative disease*-'-1
in cardiac disease "•"■*
in dermatitis
in peptic ulcer*
in neuroses & psychiatric disorders
in diabetes mellitus"-'
in alcoholism'-11-'
in ulcerative colitis1
in osteoporosis"-
in pancreatit'
in female climacteric

Patients with chronic disease desei
the nutritional support provided

Theraqran-

Squibb Vitamin-Minerals

11 vitamins, 8 miners

clinically-formulated and poter

protected to provi

enough nutritional suppl

to do some gel

with vitamins!
Theragl

also avail:

Theragran Lie;
Theragran Jut

Theragran products do not contain folifl
1-41 a list of the above references will be supplied or

Squibb §1

*THERAGRAH,-lS * SQUiBfi rRAOEN

Squibb Quality-the Priceless Ingl

THE ORIGINAL potassium phenethicillin

I

SYNCILLIN

(phenoxyethyl penicillin potassium)

A dosage form to meet the individual requirements of patients of all ages in home, office, clinic, and hospital :

Syncillin Tablets - 250 mg. (400,000 units) . . . Syncillin Tablets - 125 mg. (200,000 units)
■ .Syncillin for Oral Solution - 60 ml. bottles - when reconstituted, 125 mg. (200,000 units) per 5 ml.
Syncillin Pediatric Drops - 1.5 Gm. bottles. Calibrated dropper delivers 125 mg. (200,000 units)

Complete information on indications, dosage and precautions is included in the circular accompanying each package.

BRISTOL LABORATORIES, SYRACUSE, NEW YORKljWm.

\ eo das •',;

•-.- far
SenKrrt/tyir

Actual case summary
from the files of
Bristol Laboratories'
Medical Department

SYNCILLIN®

250 mg. q.i.d. - 5 days

B.G. 9-year-old, white male. First seen Aug. 11,
1959 with acute tonsillitis. Illness of 3 days'
duration. Beta hemolytic streptococcus extremely
sensitive to SYNCILLIN cultured from the throat.

Patient started on SYNCILLIN - 250 mg. q.i.d.
After 5 days, the infection appeared cured and
the antibiotic was discontinued. No subjective or

objective evidence of side reactions.

i- >';.-. ; » ... . . v v-.. •• v . _'-- * _ . ,

XLIV

XORTT1 CAROLINA MEDICAL JOURNAL

November. I960

ALL OVER AMERICA!

KENTwiththe MICRONITE FILTER

IS SMOKED BY
MORE SCIENTISTS and EDUCATORS

than any other cigarette!*

FIVE
SMO

KENT.

BRAND "A f
BRAND G
BRAND "F"
BRAND "B r

TOP

<ED

BRANDS OF
BY AMERICAN

CIGARETTES
SCIENTISTS

15.3%
10.3%

7.9%
7.6%
7.3%

FIVE

TOP

BRANDS

OF

CIGARETTES

SMOKED

BY AMERICAN

EDUCATORS

KENT.

BRAND "G :

20.2%
8.0%

BRAND "E "i:

7.7%

BRAND -A" *

7.7%

BRAND "F" a

7.0%

This does not constitute a
professional endorsement
of Kent. But these men, like
millions of other Kent smokers,
smoke for pleasure, and choose
their cigarette accordingly.

If you would like the booklet, "The Story of Kent", for your
own use, write to: P. Lorillard Company — Research De-
partment, 200 East 42nd Street, New York 17, New York.

The rich pleasure of smoking
Kent comes from the flavor
of the world's finest natural
tobaccos, and the free and
easy draw of Kent's famous
Micronite Filter.

■ iNO mi

iioui.i 1111

oi ClUIN.rwo* 101

For good smoking taste, ||F fEIMlW

it makes good sense to smoke mM 11811111

sfc Results ol a continuing study of Ogarell* preferences conducted by O'Brien Snerwood Associates, NY.NY.
A PRODUCT OF P LOfiiLLARD COMPANY FIRST WIT* THE FINEST CIGARETTES THROUGH LORiLLARD RESEARCH

O *■.-*.« r- CO

November, 1960

ADVERTISEMENTS

XLV

taken at bedtime

BONADOX

STOPS MORNI

OFTEN WITH JUST
ONE TABLET DAILY

by treating the symptom —
nausea and vomiting— as well
as a possible specific cause—
pyridoxine deficiency

each tiny Bonadoxin
tablet contains:
Meclizine HC1 (25 mg.)
for antinauseant action
Pyridoxine HC1 (50 mg.)
for metabolic replacement.

usual dose: One tablet at
bedtime; severe cases may require
another tablet on arising.

supply: Bottles of 25 and
100 tablets. Bonadoxin also
effectively relieves nausea and
vomiting associated with:
anesthesia, radiation sickness,
Meniere's syndrome, labyrinthitis,
and motion sickness. Also useful in
postoperative nausea and vomiting.

Bibliography on request.

For infant colic, try
Bonadoxin Drops. Each cc.
contains: Meclizine 8.33 mg./
Pyridoxine 16.67 mg.

New York 17, N. Y.

Division, Chas. Pfizer & Co., Inc.

Science for the World's Well-Being'*

and . . . when your OB patient needs the best
in prenatal vitamin-mineral supplementation .

OBROr

XLVI

NORTH CAROLINA MEDICAL JOURNAL

November, !!• '0

FflDlE SIMHJL¥AME(Q)IUS flMMMMMMMM

A(KMMot4 MSEASESS

Poliomyelitis -Diphtheria-Pertussis -Tetanus

PEDI -ANTICS

' BEEN
WORKING
ON A
NEW

TETRAVAX

DIPHTHERIA AND TETANUS TOXOIDS WITH PERTUSSIS AND POLIOMYELITIS VACCINES

now you can immunize against more diseases . . . with fewer injections

Do3e : 1 cc.

Supplied: 9 cc. vials in clear plastic cartons. Pack-
age circular and material in vial can be examined
without damaging carton. Expiration date is
on vial for checking even if carton is discarded.

For additional information, write Professional Services, Merck Sharp & Dohme, West Point, Pa.

TtTBAVAX IS A TAAOEMAOK OF MCHCK t CO,, IN

?5 MERCK SHARP & DOHME, division of merck & co.. inc., Philadelphia i, pa.

I

November, 1960

ADVERTISEMENTS

XLVII

Don't settle for
slow-power" x-ray

v-* &*J

4

T

^ \.%

ro

get a full 200-ma with your Patrician combination

When anatomical motion threatens to blur ra-
diographs, the 200-ma Patrician can answer
with extreme exposure speed, twice that of any
100-ma installation. Film images show im-
proved diagnostic readability . . . retakes are
fewer. And you'll find the G-E Patrician is like
this in everything for radiography and fluoro-
scopy: built right, priced sensibly, uncompro-
mising in assuring you all basic professional
advantages. Full-size 81" table . . . independ-
ent tubestand . . . shutter limiting device . . .
automatic tube protection . . . counterbalanced
fluoroscope, x-ray tube and Bucky . . . full-
wave x-ray output.

You also can rent the Patrician —

through G-E Maxiservice® x-ray rental plan.
Gives you the complete x-ray unit, plus main-
tenance, parts, tubes, insurance, local taxes —
everything — for one, uniform monthly fee. Get
details from your local G-E x-ray representa-
tive listed below.

«&=***-',

\

progress Is Our Most Important Product

GENERAL H ELECTRIC

Direct Factory Branch
CHARLOTTE

1140 Elizabeth Ave.
FR 6-1531

NORTH CAROLINA

Resident Representatives
WILSON

A. L. Harvey

1501 Branch St. • Phone 23 7-2440

WINSTON-SALEM

N. E. Bolick
1218 Miller St. • Phone PArk 4-5864

XLVIII

NORTH CAROLINA MEDICAL JOURNAL

November, 1960

Following determination
of basal secretion,
intragastric pH was
continuously determined
by means of frequent
readings over a
two-hour period.

pH

Data based on pH measurements in 11 patients with peptic ulcer1

40

Neutralization
with standard
aluminum hydroxide

neutralization
is much
faster and
twice
as long
with

Minutes 20

Ne" CREAMAuWJMTACID

LABORATORIES |
New York 18, N. Y.

TABLETS

New proof in vivo' of the much greater efficacy of new Creamalin
tablets over standard aluminum hydroxide has now been ob-
tained. Results of comparative tests on patients with peptic ulcer,
measured by an intragastric pH electrode, show that newCreamalin
neutralizes acid from 40 to 65 per cent faster than the standard
preparation. This neutralization (pH 3.5 or above) is maintained
for approximately one hour longer.

New Creamalin provides virtually the same effects as a liquid
antacid2 with the convenience of a tablet.
Nonconstipating and pleasant-tasting, new Creamalin antacid
tablets will not produce "acid rebound" or alkalosis.
Each new Creamalin antacid tablet contains 320 mg. of specially
processed, highly reactive, short polymer dried aluminum hy-
droxide gel (stabilized with hexitol) with 75 mg. of magnesium
hydroxide. Minute particles of the powder offer a vastly increased
surface area for quicker and more complete acid neutralization.

Dosage: Gastric hyperacidity — from 2 to 4 tablets as necessary. Peptic
ulcer or gastritis — from 2 to 4 tablets every two to four hours. Tablets may
be chewed, swallowed whole with water or milk, or allowed to dissolve
in the mouth. How supplied: Bottles of 50, 100, 200 and 1000.
1. Data in the files of the Department of Medical Research, Winthrop
Laboratories. 2. Hinkel, E. T., Jr.; Fisher, M. P., and Tainter, M. L.: J. Am.
Pharm. A. (Scient. Ed.) 48:384, July, 1959.

for peptic ulcera gastritis* gastric hyperacidity

November, 1960

ADVERTISEMENTS

XLIX

1 r ii e

^SSSs- ssss

» 1

ssP 1# ^aP 1 #% I 1HI Kg fc# #1 I* I I i^

*% t €^ T CI I cl T h €^ IT 3 D V

%& §§§

prednisolone

TM

^phiw

■MKMMmMMMMMQMMMWMMNNllMIMMal

S^ ^s

Paiiy

Ulalnteoanse Pose

■ Better therapeutic response

■ Reduced daily dosage

■ Fewer side effects

■ Greater safety, convenience
and economy

Now, for the first time,
the benefits of steroid therapy
are enhanced by sustained release
PREDLON PELSULES.

USES: Rheumatoid arthritis,
disseminated lupus erythematosus,
allergic diseases, and
other conditions where the
use of steroids is indicated.

SUPPLY: PREDLON 5 mg.
is available in bottles
of 30 and lOOPelsules.

DRUG^

Samples and Literature on request
WINSTON-SALEM 1, NORTH CAROLINA

'trademark for timed disintegration capsules

NORTH CAROLINA MKDICAL JOURNAL

November, 1900

contain
the
bacteria-prone

cold

am

(Triacetyloleandomycin, Triaminica and Calurin®)

inner

protection
with...

safe antibiosis

Triacetyloleandomycin, equivalent to oleandomycin 125 mg.
This is the URI antibiotic, clinically effective against certain
antibiotic-resistant organisms.

fast decongestion

Triaminic*, 25 mg., three active components stop running noses.
Relief starts in minutes, lasts for hours.

well-tolerated analgesia

Calurin®, calcium acetylsalicylate carbamide equivalent to
aspirin 300 mg. This is the freely-soluble calcium aspirin that
minimizes local irritation, chemical erosion, gastric damage.
High, fast blood levels.

Tain brings quick, symptomatic relief of the common cold
(malaise, headache, muscular cramps, aches and pains) espe-
cially when susceptible organisms are likely to cause secondary
infection. Usual adult dose is 2 Inlay-Tabs, q.i.d. In bottles of 50.
1} only. Remember, to contain the bacteria-prone cold... Tain.

SMITH-DORSEY • Lincoln, Nebraska
a division of The Wander Company

Pain Reliever

Professional confidence in the uniformity,
potency and purity of Bayer Aspirin is evi-
denced by ever increasing recommendation.
Bayer Aspirin is the most widely accepted
brand of analgesic the world has ever known.

We welcome your requests for samples
of Bayer Aspirin and Flavored Bayer Aspirin
for Children.

BAYER

THE BAYER COMPANY. DIVISION OF STERLING DRUG INC.. 1450 BROADWAY. NEW YORK 18. N.Y.

LI I

NORTH CAROLINA MEDICAL JOURNAL

November, 19(50

in arthritis and allied
disorders

Butazolidin*

brand of phenylbutazone

Geigy

Since its anti-inflammatory properties
were first noted in Geigy laboratories 10
years ago, time and experience have
steadily fortified the position of
Butazolidin as a leading nonhormonal
anti-arthritic agent. Indicated in both
chronic and acute forms of arthritis,
Butazolidin is noted for its striking
effectiveness in relieving pain,
increasing mobility and halting
inflammatory change.

Proved by a Decade of Experience
Confirmed by 1700 Published Reports
Attested by World-Wide Usage

Butazolidin®, brand of phenylbutazone:
Red, sugar-coated tablets of 100 mg.
Butazolidin® Alka: Orange and white
capsules containing Butazolidin 100 mg.;
dried aluminum hydroxide gel 100 mg.;
magnesium trisilicate 150 mg.;
homatropine methylbromide 1.25 mg.

Geigy, Ardsley, New York w^

162-60

November, 1960 ADVERTISEMENTS LIU

Major Hospital Policy

Pays up to $10,000.00 for each member of your family,
subject to deductible you choose

Deductible Plans available:
$100.00
$300.00
$500.00

Business Expense Policy

Covers your office overhead while you
are disabled, up to $1,000.00 per month

approved by

The Medical Society of North Carolina
for Its Members

I Write or Call

^ for information

| Ralph }. Golden Insurance Agency i

4 Ralph J. Golden Associates Henry Maclin, IV |

i

Harry L. Smith John Carson |

108 East North wood Street
Across Street from Cone Hospital

I GREENSBORO, N. C.

I P

Phones: BRoadway 5-3400 BRoadway 5-5035

I I

LIV

NORTH CAROLINA MEDICAL JOURNAL

November, liKSO

for acute

upper respiratory infections

capsules

The Original Tetracycline Phosph.it,! Complex " s "T- "°- '.'»i.«<»

effective control of pathogens... with an unsurpassed record of safety and tolerance

BRISTOL LABORATORIES, Syracuse, new york ^Bristol,

Div. of Bristol-Myers Co.

SUPPLY: TETREX Capsules -tetracycline phosphate
complex -each equivalent to 250 mg. tetracycline HCI
activity. Bottles ol 16 and 100.

TETREX Syrup -tetracycline (ammonium polyphosphate
buffered) syrup-equivalent to 125 mg. tetracycline HCI
activity per 5 ml. teaspoonful. Bottles ol 2 II. 01. and 1 pint.

November, 19(50

ADVERTISEMENTS

LV

Use of pHisoHex for washing the skin aug-
ments any other therapy for acne — brings
better results. Now, pHisoAc Cream, a new
acne remedy for topical application, sup-
presses and masks lesions — dries, peels and
degerms the skin. Together, pHisoHex and
pHisoAc provide basic complementary topical
therapy for acne.

pHisoHex, antibacterial detergent with 3 per
cent hexachlorophene, removes soil and oil
better than soap — provides continuous de-
germing action when used often. pHisoHex is
nonalkaline, nonirritating and hypoallergenic.

When pHisoAc Cream is used with pHisoHex
washings, it unplugs follicles, helps prevent

development of comedones, pustules and
scarring. New pHisoAc Cream is flesh-toned,
not greasy. It contains colloidal sulfur 6 per
cent, resorcinol 1.5 percent, and hexachloro-
phene 0.3 per cent in a specially prepared
base. pHisoAc is pleasant to use.

A new "self-help" booklet, Teen-aged? Have
acne? Feel lonely?, gives important psycho-
logic first aid for patients with acne and
describes the proper use of pHisoHex and
pHisoAc. Ask your Winthrop representative
for copies.

pHisoAc is available in 1V2 oz. tubes and
pHisoHex is available in 5 oz. plastic squeeze
bottles and in bottles of 16 oz.

pHisoHex and pHisoAc for acne

trademark

f LABORATORIES |
New York 18. N. Y.

I, VI

NORTH CAROLINA MEDICAL JOURNAL

November, l!)(il)

!'.. extraordinarily effective diuretic..'!1

Efficacy and expanding clinical use are making Naturetin the
diuretic of choice in edema ond hypertension. It maintains a
favorable urinary sodium-potassium excretion ratio, retains a
balanced electrolyte pattern, and causes a relatively small in-
crease in the urinary pH.2 More potent than other diuretics,
Naturetin usually provides 18-hour diuretic action with just a
single 5 mg. tablet per day — economical, once-a-day dosage
for the patient. Naturetin c K — for added protection in those
special conditions predisposing to hypokalemia and for patients
on long-term therapy.

Naturetin NaturetimK

Supplied: Naturetin Tablets, 5 mg., scored, and 2.5 mg. Naturetin
c K (5 c 5001 Tablets, capsule-shaped, containing 5 mg. ben-
zydroflumelhiazide and 500 mg. potassium chloride. Naturetin
c K (2.5 c 500] Tablets, capsule-shaped, containing 2.5 mg.
benzydroflumethiazide and 500 mg. potassium chloride. For com-
plete information consult package circular or write Professional
Service Dept., Squibb, 745 Fifth Avenue, New York 22, N. Y.
References. I. David, N. A.; Porter, G. A., and Gray, R. H.:
Monographs on Therapy 5:60 (Feb.l 1960. 2. Ford, R. V.: Current
Therap. Res. 2:92 (Mar.l 1960.

1

Squibb

•■'■■■. IS A MUiM ■ i. ■,--■- -

_ , ^^ . ;

Mr |

las &^l«^ /*,

Wtf*:. A* *fW?#*

the complaint: 'nervous indigestion"

the diagnosis: any of several nonspecific and functional in the gastric-soluble outer layer:

gastrointestinal disorders requiring relief of symptoms Hyoscyamine sulfate 0.0518 mg.

by sedative-antispasmodic action with concomitant Atropine sulfate 0.0097 mg.

digestive enzyme therapy. Hyoscine hydrobromide 0.0033 mg.

Phenobarbital (ys gr.) 8.1 mg.

the prescription: a new formulation incorporated in Pepsin, N. F 150 mg.

an enteric-coated tablet, providing the multiple actions jn t^e enteric-coated core:

of widely accepted Donnatal* and Entozyme.® Pancreatin, N. F 300 mg.

.. Bile salts 150 mg.

the dosage: two tablets three times a day, or as in-
dicated, antispasmodic • sedative • digestant

0 N N AZ YM

A. H. ROBINS COMPANY, INCORPORATED • RICHMOND 20, VIRGINIA

more
effective
than
salicylate
alone in
antirheumatic
therapy

PABALATE® 'f

COMBINING MUTUALLY SYNERGISTIC NON-STEROID ANTIRHEUMATICS

"superior to aspirin" — ". . . evidence seems to indicate that
the concurrent administration of para-aminobenzoic and sali-
cylic acid [as in Pabalate] produces a more uniformly sus-
tained level for prolonged analgesia and, therefore, is superior
to aspirin in the treatment of chronic rheumatic disorders."1

In each yellow enteric-coated PABALATE tablet:

Sodium salicylate (5 gr.) 0.3 Gm.

Sodium para-aminobenzoate (5 gr.) 0.3 Gm.

Ascorbic acid 50.0 mg.

For the patient who should avoid sodium

PABALATE-SODIUM FREE

Same formula as Pabalate, with sodium salts replaced by potassium salts (pink)

For the patient who requires steroids

PABALATE-HC

Pabalate with Hydrocortisone

In each light blue enteric-coated PABALATE-HC tablet:

Hydrocortisone 2.5 mg.

Potassium salicylate (5 gr.) 0.3 Gm.

Potassium para-aminobenzoate (5 gr.) 0.3 Gm.

Ascorbic acid 50.0 mg.

1. Ford, R. A., and Blanchard, K.: Journal-Lancet 78:185, 1958.

A. H. ROBINS CO., INC., Richmond 20, Virginia

November, 1960

ADVERTISEMENTS

LVII

1,928 published cases in the two years since
TAO was released for general use show:

m common

Gram-positive

infections

due to

susceptible

organisms

YOU CAN
COUNT ON

TAG

(tnacetyloleandomycin)

even

in many

resistant

Staph*

94.3% effectiveness in respiratory infections (617 cases

including tonsillitis, staphylococcal and streptococcal pharyngi-
tis, bronchitis, infectious asthma, broncho- pneumonia, lobar
pneumonia, bronchiectasis, lung abscess, otitis.)

You can count on TAO.

92% effectiveness in skin and soft tissue infections (900

cases including pyoderma, impetigo, acne, infected skin disor-
ders, wounds, incisions and burns, furunculosis, abscess, celluli-
tis, chronic ulcer, adenitis.) You can count on TAO.

87.1% effectiveness in genitourinary infections (349

cases including urethritis, cystitis, pyelitis, pyelonephritis, orchi-
tis, pelvic inflammation, acute gonococcal urethritis, lympho-
granuloma venereum.) You can count on TAO.

75.8% effectiveness in diverse infections(62 cases includ-
ing fever of undetermined origin, peritoneal abscess, osteitis,
periarthritis, septic arthritis, staphylococcal enterocolitis, gas-
troenteritis, carriers of staphylococci.) You can count on TAO.

95.6% of 1,928 cases free of side effects— in the .emain-

ing 4.4%, reactions were chiefly mild gastrointestinal disturb-
ances which seldom necessitated discontinuance of therapy.

*'ln 884 of 1,928 cases the causative organisms were mostly

staphylococci. The majority of clinical isolates were found to be

resistant to at least one of the commonly used antibiotics and

many patients had failed to respond to previous therapy with one

or more antibiotics. TAO proved 93.4% effective in these 884

cases.

Complete bibliography available on request.

DOSAGE: varies according to severity of infection. Usual adult

dose— 250 to 500 mg. q.i.d. Usual pediatric dose: 3-5 mg.. lb.

body weight every 6 hours.

NOTE: In some children, when TAO was administered at considerably
higher than therapeutic levels tor extended periods, transient-jaundice
and other indications of liver dysfunction have been noted. A rapid and
complete return to normal occurred when TAO was withdrawn.

SUPPLY: TAO CAPSULES-250 mg. and 125 mg., bottles of 60.
TAO ORAL SUSPENSION -125 mg. per 5 cc. when reconstituted,
palatable cherry flavor, 60 cc. bottles. TAO PEDIATRIC DROPS-
100 mg. per cc. when reconstituted, flavorful; special calibrated
dropper, 10 cc. bottles. INTRAMUSCULAR or INTRAVENOUS -
10 cc. vials, as oleandomycin phosphate.

OTHER TAO FORMULATIONS ALSO AVAILABLE: TA0 = -AC fTao, analgesic,
antihistaminic compound) capsules, bottles of 36. TAOMID* fTao with
Triple Sulfas) — tablets, bottles of 60. Oral Suspension-60 cc. bottles.

for nutritional support V1TERR A~ Vitamins and Minerals

Formulated from Pfizer's line of fine pharmaceutical products.

New York 17, N.Y.

Division, Chas. Pfizer & Co., Inc.

Science for the World's Well-Being'"

.VIII

NORTH CAROLINA MEDICAL JOURNAI

November, littiu

How to be
Carefree
Without
Hardly
Trying . • •

It really takes a load off your mind. . .
to know that you are protected from
loss of income due to illness or accident'

"Dr. Carefree" has no 30-day
sick leave ... no Workmen's
Compensation . . . BUT he has a
modern emergency INCOME PROTEC-
TION PLAN with Mutual of Omaha.

When he is totally disabled by accident or sickness covered by this plan, this plan
will give him emergency income, free of Federal income tax, eliminating the night-
mare caused by a long disability.

Thousands of members of the Medical Profession are protected with Mutual of Oma-
ha's PROFESSIONAL MEN'S PLAN, especially designed to meet the needs of the
profession.

If you do not already own a Mutual of Omaha INCOME PROTECTION PLAN, get in
touch now with the nearest General Agent, listed below. You'll get full details, with-
out obligation.

m

OF OMAHi

Largest Exclusive Health and Accident Company in the World.

G. A. RICHARDSON, General Agent
Winston-Salem, N. C.

J. A. MORAN, General Agent
Wilmington, N. C.

J. P. GILES, General Agent
Asheville, N. C.

November, 1960

ADVERTISEMENTS

LXI

I. XII

NORTH CAROLINA .MEDICAL JOURNAL

November, I960

RELIEVE ALL

COMMON

COLD

SYMPTOMS
AT ONCE fe

<¥

BURROUGHS WELLCOME & CO.
(U.S.A.) INC., Tuckahoe, N. Y.

WITH

'EMPRAZIL

THE TOTAL COLD-THERAPY TABLET

nasal decongestant • analgesic
antipyretic • antihistamine

The ingredients combined in each 'Emprazil' tablet
provide multiple drug action for prompt sympto-
matic relief of aches, pains, fever and respiratory
congestion — due to common colds, flu or grippe —
without gastric irritation.

Dosage: Adults and older children — One or two tablets
t.i.d. as required. Children 6 to 12 years of age — One
tablet t.i.d. as required.

Supplied: Bottles of 100 or 1000

Each orange and yellow layered tablet contains:
'Sudafed'* brand Pseudoephedrine Hydrochloride. 20 mg.
'Perazir® brand Chlorcyclizine Hydrochloride .... 15 mg.

Acetophenetidin 150 mg.

Aspirin (Acetylsalicylic Acid) 200 mg.

Caffeine 30 mg.

Complete literature available on request.

November, 1960

ADVERTISEMENTS

LXII1

IN CONTRACEPTION...

WHY IS SPEEDIER SPERMICIDAL ACTION IMPORTANT?

Because a swift-acting spermicide best meets the variables of spermatozoan activity.

Lanesta Gel, ". . . found to immobilize human sper-
matozoa in one-third to one-eighth the time required
by five of the leading contraceptive products currently
available . . ."* thus provides the extra margin of
assurance in conception control. The accelerated
action of Lanesta Gel — it kills sperm in minutes in-
stead of hours — may well mean the difference
between success and failure.

"Berberian, D. A., and Slighter, R. G.: J.A.M.A. 168:2257
(Dec. 27) 1958.

In Lanesta Gel 7 ' -chloro-4-indanol, a new, effective,
nonirritating, nonallergenic spermicide produces im-
mediate immobilization of spermatozoa in dilution
of up to 1:4,000. Spermicidal action is greatly accel-

erated by the addition of 10% NaCl in ionic form.
Ricinoleic acid facilitates the rapid inactivation and
immobilization of spermatozoa and sodium lauryl
sulfate acts as a dispersing agent and spermicidal
detergent.

Lanesta Gel with a diaphragm provides one of the
most effective means of conception control.
However, whether used with or without a
diaphragm, the patient and you, doctor, can
be certain that Lanesta Gel provides faster
spermicidal action — plus essential diffusion
and retention of the spermicidal agents in
a position where they can act upon the
spermatozoa.

Lanesta Gel

Supplied: Lanesta Exquiset . . . with diaphragm of prescribed size and type; universal introducer; 1 f^ QfodllCt '

Lanesta Gel, 3 oz. tube, with easy clean applicator, in an attractive purse. Lanesta Gel, 3 oz. tube with ; * I antftph®

applicator; 3 oz. refill tube — available at all pharmacies. ; ■•'.»>«""*'«»

Manufactured by Esta Medical Laboratories, Inc., Alliance, Ohio Distributed by George A Breon & Co., New York IX. N. V „ '*.T^-~o ■

I, XIV

NORTH CAROLINA MEDICAL JOURNAL

November, I960

Now... the only

Nystatin combination

with extra-active

D

DECLOMYCIN

Demethylchlortetracycline

with extra-broad spectrum benefits:—
action at lower milligram intake... broad-
range action... sustained peak activity...
extra-day security against resurgence of
primary infection or secondary invasion.

EOLOSTATIN@

Demethylchlortetracycline and Nystatin LEDERLE

CAPSULES, 150 mg. DECLOMYCIN Demethylchlortetracycline HCl and 250,000 units Nystatin.

DOSAGE: average adult, 1 capsule four times daily.

LEDERLE LABORATORIES, A Division of AMERICAN CYANAMID COMPANY, Pearl River, New York

November, I960

ADVERTISEMENTS

LXV

whenever depression
complicates the picture

In many seemingly mild physical disorders
an element of depression plays an
insidious etiologic or complicating role.

Because of its efficacy as an antidepres-
sant, coupled with its simplicity of usage,
Tofranil is admirably adapted to use in the
home or office in these milder "depression-
's complicated" cases.
#

Tofranil

brand of imtpramine HCI

hastens recovery

Geigy

It is always wise to recognize that depres-
sion may be an underlying factor... that
Tofranil may speed recovery in "hypochon-
driasis"; in convalescence when recovery
is inexplicably prolonged; in chronic illness
with dejection; in the menopausal patient
whose emotional disturbances resist
hormone therapy; and in many other com-
parable situations in which latent depres-
sion may play a part.

Detailed Literature Available on Request.

Tofranil*, brand of imipramine hydrochloride,
tablets of 25 mg. Ampuls for intramuscular
administration, 25 mg. in 2 cc. of solution.

Geigy, Ardsley, New York faig

160-60

LXVI

NORTH CAROLINA MEDICAL JOURNAL

November, 1960

REGULATORS

"Essential" fatty acids . . . arachidonic and lino-
leic . . . and fat-soluble vitamins . . . A. D and K.
. . . can be obtained from everyday foods. These
nutrients serve essential but obscure roles in
maintenance of body membranes and skin. In-
testinal absorption of calcium, mineralization of
bone and teeth, and clotting of blood.

From foods listed in A Guide to Good Ealing,
the "essential" fatty acids are obtained from the
fat present in milk, cheese, ice cream, butter,
eggs, meat, fish, poultry, nuts . . . and in larger
amounts, from some natural fats and oils used in
food preparation and at table. Vitamin A value
is generously supplied by milk fat in dairy foods,
eggs, dark green leafy vegetables, yellow vege-
tables and fruits.

Vitamin D . . . important for absorption and
utilization of calcium during growth, pregnancy
and lactation ... is not amply provided by foods
listed in the "Guide" . . . unless vitamin D-forti-
hed milk is used in recommended amounts. Vita-
min D can be formed in the skin if it is exposed
to sunlight or ultraviolet lamp.

Many foods listed in the "Guide" supply vita-
mins E and K. . . . i. e. green leafy vegetables, nuts
and dairy foods containing milkfat. Plant oils
used for salads or food preparation are rich in
vitamin E. Microorganisms form \itamin K in
the intestines.

A GUIDE TO GOOD EATING — USE DAILY
DAIRY FOODS

3 to 4 glasses milk — children • 4 or more glasses —
teenagers • 2 or more glasses — adults • Cheese, ice
cream and other milk-made loods can supply part of
the milk

MEAT GROUP
2 or more servings • Meats, fish, poultry, eggs, or
cheese — with dry beans, peas, nuts as alternates

VEGETABLES AND FRUITS

4 or more servings • Include dark green or yellow
vegetables; citrus fruit or tomatoes

BREADS AND CEREALS

4 or more servings • Enriched or whole-grain added
milk improves nutritional values

When combined in well-prepared meals, foods
selected from each of the four food groups can
provide all of the necessary fat-soluble vitamins
and fatty acids . . . while satisfying the tastes,
appetites and other nutrients needs of all mem-
bers of the family . . . young and old.

The nutritional statements made in this adver-
tisement have been reviewed by the Council on
Foods and Nutrition of the American Medical
Association and found consistent with current
authoritative medical opinion. f

Since 1915 . . . promoting better health
through nutrition research and education.

NATIONAL DAIRY COUNCIL

A non-profit organization
111 N. Canal Street • Chicago 6, 111.

Salute to the American Dental Association on A Century of Health Service

This information is reproduced in the interest of good nutrition and health by the Dairy

Council Units in North Carolina.
High Point-Greensboro Winston-Salem Burlington-Durham-Raleigh

106 E. Northwood St. 610 Coliseum Drive 310 Health Center Bldg.

Greensboro, N. C. Winston-Salem, N. C. Durham, N. C.

November, 1960

ADVERTISEMENTS

LXVII

&w //e 9B«/9b*« </&&

WW

ORIGINAL FORMULA

NICOZOL COMPLEX is a cerebral stimulant-tonic and dietary
supplement intended for geriatric use. Improves mental and
physical well-being. Improves protein and calcium metabolism.
Indicated during convalescence, also as a preventive agent in
common degenerative changes.

NICOZOL COMPLEX is avail-
able as a pleasant-tasting
elixir. Popularly priced.
Bottles of 1 pint and 1 gallon.

%XJc6€tae.-

1 teaspoonful (5 cc) 3 times a day,
preferably before meals. Female pa-
tients should follow each 21-day
course with a 7-day rest interval.

Write for professional sample and literature.

DRUG^

(^Sp^claHle^) WINSTON-SALEM 1, NO

Each 15 cc (3 teaspoonfuls) contains!

Pentylenetetrazol 150 mg.

Niacin 75 mg.

Methyl Testosterone 2.5 mg.

Ethinyl Estradiol 0.02 mg.

Thiamine Hydrochloride 6 mg.

Riboflavin 3 mg.

Pyridoxine Hydrochloride 6 mg.

Vitamin B-12 2 meg.

Folic Acid 0.33 mg.

Panthenol 5 mg.

Choline Bitartrate 20 mg.

Inositol 15 mg.

1-Lysine Monohydrochlonde .. 100 mg.
Vitamin E (a-Tocopherol

Acetate) 3 mg.

Iron (as Ferric Pyrophosphate) 15 mg.

Trace Minerals as: Iodine 0.05 mg.,

Magnesium 2 mg., Manganese 1 mg.,

Cobalt 0.1 mg., Zinc 1 mg.
Contains 15% Alcohol

RTH CAROLINA

LXVIII

NORTH CAROLINA MEDICAL JOURNAL

November, 1960

IN GOLDS AND SINUSITIS-

THE RIGHT AMOUNT OF "INNER SPACE

RIGHT AWAY

QjjwitiiW)

LABORATORIES
New York 18, N. Y.

NEO-SYNEPHRINE

(Brand of phenylephrine hydrochloride)

hydrochloride

NASAL SOLUTIONS AND SPRAYS

Neo-Synephrine hydrochloride relieves the boggy
feeling of colds immediately and safely, without
causing systemic toxicity or chemical harm to nasal
membranes. Turbinates shrink, sinus ostia open,
ventilation and drainage resume, and mouth-breath-
ing is no longer necessary.

Gentle Neo-Synephrine shrinks nasal membranes
for from two to three hours without stinging or
harming delicate respiratory tissues. Post-thera-
peutic turgescence is minimal. Neo-Synephrine does
not lose its effectiveness with repeated applications
nor does it cause central nervous stimulation, jitters,
insomnia or tachycardia.

Neo-Synephrine solutions and sprays produce shrink-
age of tissue without interfering with ciliary activity
or the protective mucous blanket.

For wide latitude of effective and safe treatment,
Neo-Synephrine hydrochloride is available in nasal
sprays for adults and children; in solutions from
Vs% t0 1%; and in aromatic solution and water
soluble jelly.

November, 1960

ADVERTISEMENTS

LXIX

BETTER GET YOURS /

FIRST doctor/

Money goes fast at Christmas time,
Doctor . . . best you start getting yours now.

And one of the best ways to get your
money before December spending starts, is
to call the Medical-Dental Credit Bureau
nearest you today. They'll clear up your
overdue accounts ... in an ethical, cour-
teous manner . . . and keep your patients
happy, too.

Yes, to beat those December charge
accounts to the draw, call your Medical-
Dental Credit Bureau NOW!

MEDICAL- DENTAL CREDIT BUREAUS

Greensboro— 212 W. Gaston Street — BRoodway 3-825S
High Point — 310 N. Main Street — 88 3-1955
Winston-Salem — 514 Nissen Building — PArk 4-8373
Asheville — Westgate Regional Shopping Center — ALpinc 3-7378

Lumberton — 220 Eost Fifth Street — REdfield 9-3283
Reidsville — 205'/2 W. Morehead Street — Dickens 9-4325
Charlotte — 225 Hawthorne Lane — FRanklin 7-1527
Wilmington — Masonic Temple Building, Room 10 — ROger 3-5191

North Carolina Members — Nation-jl Association Medical - Dentcl Bureaus

TUCKER HOSPITAL, Inc.

212 West Franklin Street
Richmond, Virginia

A private hospital for diagnosis and treatment of psychiatric and neurol-
ogical patients.
Hospital and out-patient services.

(Organic diseases of the nervous system, psychoneuroses, psychosomatic
disorders, mood disturbances, social adjustment problems, involutional
reactions and selective psychotic and alcoholic problems.)

Dk. James Asa Shield

Dr. Weir M. Tucker

Dr. George S. Fultz

Dr. Amelia G. Wood

r,XX

NORTH CAROLINA MEDICAL JOURNAL

November, 1960

STOP

CLIMBING

STAIRS

Avoid

Heart Strain

and Fatigue

with a

Home Elevator

Inclin-ator travels up and down
stairways — Elevette fits snugly
into closet space. Ideal for in-
valids and older folks, with safe
push-button controls. Uses or-
dinary house current. Used in
hundreds of nearby homes. Call
or write today for free survey.

1

ELEVATORS

Freight & Passenger Elevators

Greensboro, North Carolina

Charlotte t Raleigh

Roanoke • Augusta • Greenville

Protection Against Loss of Income
from Accident & Sickness as Well as
Hospital Expense Benefits for You and
All Your Eligible Dependents

£11

PREMIU MS

COME FROM

PHYSICIANS
SURGEONS
DENTISTS

All

BENEFITS

60 TO

PHYSICIANS CASUALTY & HEALTH
ASSOCIATIONS

OMAHA 31, NEBRASKA
Since 1902

jandsome Professional Appointment Book sent to
you FREE upon request.

CJ

r^v

Of special

significance

to the

physician

is the symbol

When he sees it engraved
on a Tablet of Quinidine Sulfate

he has the assurance that

the Quinidine Sulfate is produced

from Cinchona Bark, is alkaloidally

standardized, and therefore of

unvarying activity and quality.

When the physician writes "DR"
(Davies, Rose) on his prescriptions
for Tablets Quinidine Sulfate, he is

assured that this "quality" tablet
is dispensed to his patient.

Rx Tablets Quinidine Sulfate Natural

0.2 Gram (or 3 grains)

Davies, Rose

Clinical samples sent to physicians on request

Davies, Rose &_ Company, Limited
Boston 18, Mass.

0.7

November, 1960

ADVERTISEMENTS

LXXI

BRAWNER'S SANITARIUM, INC,

(Established 1910)
2932 South Atlanta Road, Smyrna, Geoi-gia

FOR THE TREATMENT OF PSYCHIATRIC ILLNESSES
AND PROBLEMS OF ADDICTION

MODERN FACILITIES

Approved by Central Inspection Board of American Psychiatric Association
and the Joint Committee on Accreditation

Jas. N. Brawner, Jr., M.D.
Medical Director

Phone H Em lock 5-4486

HIGHLAND HOSPITAL, INC.

Founded In 1904

ASHEVILLE, NORTH CAROLINA

Affiliated with Duke University

A non-profit psychiatric instilution, offering modern diagnostic and treatment procedures — insulin, electroshock, psy-
chotherapy, occupational and recreational therapy — for nervous and mental disorders.

The Hospital is_ located in a 75-acre park, amid the scenic beauties of the Smoky Mountain Range of Western North
Carolina, affording exceptional opportunity for physical and emotional rehabilitation.

The OUT-PATIENT CLINIC offers diagnostic service and therapeutic treatment for selected case desiring non-
resident care.

R. CHARMAN CARROLL, M.D. ROBERT L. CRAIG, M.D. JOHN D. PATTON, M.D.
Medical Director Associate Medical Director Clinical Director

LXXII

NORTH CAROLINA MEDICAL JOURNAL

November, I960

FOR THE
AGING . . .

NEW

COMPREHENSIVE SUPPORT

BALANCED HORMONE SUPPLEMENTATION

▲
BROAD NUTRITIONAL REINFORCEMENT

Geriatric Vitamins-Minerals-Hormones-d-Amphetamine Lederle

Each capsule contains: Ethinyl Estradiol 0.01 mg. • Methyl
Testosterone 2.5 mg. • d-Amphetamine Sulfate 2.5 mg. • Vitamin
A (Acetate) 5,000 U.S. P. Units • Vitamin D 500 U.S. P. Units •
Vitamin B„ with AUTRINIC* Intrinsic Factor Concentrate 1/15
U.S. P. Unit (Oral) • Thiamine Mononitrate (B,) 5 mg. • Ribo-
flavin (Bi) 5 mg. • Niacinamide 15 mg. • Pyridoxine HCI (B,)
0.5 mg. • Calcium Pantothenate 5 mg. • Choline Bitartrate
25 mg. • Inositol 25 mg. • Ascorbic Acid (C) as Calcium Ascorbate

50 mg. • l-Lysine Monohydrochloride 25 mg. • Vitamin E
(Tocopherol Acid Succinate) 10 Int. Units • Rutin 12.5 mg. •
Ferrous Fumarate (Elemental iron, 10 mg.) 30.4 mg. • Iodine
(as Kl) 0.1 mg. • Calcium (as CaHPOj) 35 mg. • Phosphorus (as
CaHPOJ 27 mg. • Fluorine (as CaFj) 0.1 mg. • Copper (as CuO)
1 mg. • Potassium (as KjSOj) 5 mg. • Manganese (as MnOj)
1 mg. • Zinc (as ZnO) 0.5 mg. • Magnesium (MgO) 1 mg. • Boron
(as Na2B,0,.10HiO) 0.1 mg. Bottles of 100, 1000.

LEDERLE LABORATORIES, a Division of AMERICAN CYANAMID COMPANY, Pearl River, New York

SAINT ALBANS

PSYCHIATRIC HOSPITAL

(A Non-Profit Organization)

Radford, Virginia

James P.
Daniel D. Chiles, M. D.

Clinical Director
James K. Morrow, M. D.
Silas R. Beatty, M. D.

STAFF

King, M. D., Director

William D. Keck, M. D.
Edward W. Gamble, III, M. D.
J. William Giesen, M. D.
Internist (Consultant)

Clinical Psychology: Don Phillips
Thomas C. Camp, Ph. D. Administrator
Artie L. Sturgeon, Ph. D.

AFFILIATED CLINICS
Bluefield Mental Health Center Beckley Mental Health Center

525 Bland St., Bluefield, W. Va. 109 E. Main Street, Beckley, W. Va.
David M. Wayne, M. D. W. E. Wilkinson, M. D.
Phone: DAvenport 5-9159 Phone: CLifford 3-8397
Charleston Mental Health Center Norton Mental Health Clinic

1119 Virginia St., E., Charleston, W. Va. Norton Community Hospital, Norton, Va.
B B Young M. D. Pierce D. Nelson, M. D.
Phone: Dickens 6-7691 Phone: 218, Ext. 55 and 56

news

For Easy Management
of Iron Deficiency Anemia

CEVIRATE ta^ts

OPTIMAL HEMOGLOBIN REGENERATION
MINIMAL GASTROINTESTINAL IRRITATION

CEVIRATE TABLETSsupply high level iron dosage in the form of well-tolerated, effective
ferrous fumarate, in combination with ascorbic acid.

Providing a higher elemental iron content than other commonly used salts of iron, fer-
rous fumarate is less irritating to the gastrointestinal tract.1 Clinical investigation has
shown ferrous fumarate to be "an effective oral preparation for the treatment of iron
deficiency anemia,"3 producing a "minimum of gastrointestinal irritation"2 and an "ex-
cellent"' therapeutic response.

The inclusion of ascorbic acid affords protection to the ferrous ion and enhances hemo-

globin response. The association between Vitamin C, blood formation and anemia
has been noted by many investigators3 and clinical studies have shown a relationship
between the development of anemias and prolonged Vitamin C deficiencies.4

In CEVIRATE TABLETSthe combination of ferrous fumarate and ascorbic acid insures
effective, prompt hemoglobin regeneration with a minimum of side effects in the treat-
ment of iron deficiency anemias.

DOSE: Adults, one tablet two to three times daily.

Each CEVIRATE tablet contains:

FERROUS FUMARATE 300 Mg.

Providing 99 Mg. of elemental iron

ASCORBIC ACID 100 Mg.

Red, Capsule-Shaped Tablets, NOT ENTERIC COATED ! !

References:

1. Shapleigh, J. B.: Ferrous Fumarate, A Clinical Trial of A New Iron Compound, Am. Pract. Dig. Treat.; March, 1959.

2. Feldman, Harold S.: Ferrous Fumarate in the Treatment of Iron Deficiency Anemia, Va. Med. Monthly, Vol. 87, April, 1960.

3. Lancet (editorial) 2:923, 1953.

4. Quart. J. Med. 22:309, 1953 and Blood 7:671, 1952.

CEVIRATE TABLETS ARE SUPPLIED IN BOTTLES OF 100 AND 1000 TABLETS

I"

UTCRATUM

OlAOlr Mm

UPON MQUCST

SSHi

PRODUCTS CO.,l»

PETERSBURG. VIRGIN

new;

\ Palatable Hematinic Tablet

or Easy Management of

on Deficiency Anemia In Childrer

CEVIRATE

PEDIATRIC

CEVIRATE PEDIATRIC combines ferrous fumarate and ascorbic acid in a tasty, pineapple flavored soft-
tablet that may be swallowed, chewed, or allowed to dissolve in the mouth.

This unique dosage form is made possible by the use of iron in its newest and best tolerated form, ferrous
fumarate. Almost tasteless and completely free from the characteristic pungent taste and odor usually
associated with iron salts, this new compound makes possible a children's dosage form that insures an
enthusiastic reception by children of all ages.

DOSAGE:

One to three tablets daily, either chewed, swallowed or allowed to dissolve in mouth.

Each CEVIRATE PEDIATRIC Tablet
contains:

FERROUS FUMARATE 100 mg.

Providing 33 mg. of elemental iron

ASCORBIC ACID 50 mg.

Supplied in Bottles of 100

Ferrous Fumarate

Excels Other Iron Compounds Because:

IT YIELDS MORE ELEMENTAL IRON

IT IS ABSORBED QUICKLY AND EFFICIENTLY

IT IS BETTER TOLERATED

IT HAS NO TYPICAL "IRON" TASTE

IT HAS A HIGHER MARGIN OF SAFETY

IT PRODUCES EXCELLENT HEMOGLOBIN RESPONSE

MORE ELEMENTAL IRON TO PROVIDE

A BETTER HEMOGLOBIN RESPONSE ! !

FERROUS
FUMARATE

337c

FERROUS SULFATE
EXSICCATED U.S. P.

317c

FERROUS SULFATE
US P.

20%

FERROUS LACTATE N.F.

19%

FERROUS GLUCONATE U.S. P.
12%

A COMPARISON OF ELEMENTAL IRON CONTENT FROM FERROUS SALTS

SAMPISS AND

«TU»I
6LADIY SINT

mmmmaimm

PRODUCTS CO., IN

PETERSBURG. V I RGI N I j

November, 1960

ADVERTISEMENTS

LXXIII

ASHEVILLE

APPALACHIAN HALL

ESTABLISHED — 1916

NORTH CAROLINA

An Institution for the diagnosis and treatment of Psychiatric and Neurological illnesses, rest, convalescence, drug

and alcohol habituation.

Insulin Coma, Electroshock and Psychotherapy are employed. The Institution is equipped with complete laboratory

facilities including electroencephalography and X-ray.

Appalachian Hall is located in Asheville, North Carolina, a resort town, wnich justly claims an all around climate

for health and comfort. There are ample facilities for classification of patients, rooms single or en suite.

Wm. Ray Griffin, Jr., M.D.
Robert A. Griffin, M.D.

For rates and further information write

Mark A. Griffin, Sr., M.D.
Mark A. Griffin, Jr., M.D.

APPALACHIAN HALL, ASHEVILLE, N. C.

WE PROUDLY DRAW YOUR ATTENTION

This is Diapulse®. You may lie seeing it here for
the first time, for it has just begun to flow off the
production lines at Remington-Rand.

It emits pulsed short waves. Not ordinary short
waves, whose power is limited by the danger of over-
heating— but very strong short waves with intervals
of rest between to allow for dissipation of heat.

Experience in laboratory and clinic indicates that
this modality is unique in its ability to stimulate
cellular activity. Any number of medical men — many
of them world-renowned — believe that treatment by
Diapulse has the capacity for aiding the patient by
causing his defense mechanism to respond with
greater zeal and efficiency.

We are proud to offer this fine piece of equipment to our many customers.
Write or ask our salesman for demonstration.

CAROLINA SURGICAL SUPPLY COMPANY

s

706 Tucker St.

'The House of Friendly and Dependable Service"

Tel: TEmple 3-8631

Raleigh, North Carolina

LXXIV

NORTH CAROLINA MEDICAL JOURNAL

November, I960

RY

CHOSEN BY MEDICAL
SOCIETY OF THE STATE OF
NORTH CAROLINA FOR
PROFESSIONAL
LIABILITY INSURANCE

for your complete insurance needs . . .

^PROFESSIONAL
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Head Office
412 Addison Building
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EDison 2-1633

SERVICE OFFICE: RALEIGH, NORTH CAROLINA— 323 W. MORGAN ST. TEmple 4-7458

HOME OFFICE: 385 WASHINGTON ST., ST. PAUL, MINN

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seem to crowd

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a welcome

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November, I960

ADVERTISEMENTS

LXXV

INDEX TO ADVERTISERS

Abbott Laboratories XXXIV

American Casualty Insurance Company LIII

American Medical Association IX

Ames Company LX

Appalachian Hall LXXIII

Brawner's Sanitarium LXXI

Brayten Pharmaceutical Company XXV

George A. Breon LXIII

Bristol Laboratories XXVIII, XXX, XLlII, LIV

Burroughs-Wellcome & Company LXII

Carolina Surgical Supply Co LXXIII

Coca Cola Bottling Company LXXIV

Columbus Pharmacal Company LXI

J. L. Crumpton XL

Dairy Council of North Carolina L-^YJ

Davies, Rose & Co LXX

Drug Specialties, Inc XLIX, LXVII

Endo Laboratories XXIV

Floi-ida Citrus Commission XII

Geigy Pharmaceutical LII, LXV

General Electric X-Ray Dept. XLVII

Glenbrook Laboratories (Bayer Co.) LI

Charles C. Haskell and Company XXXIII

Highland Hospital LXXI

Hospital Saving Assn. of N. C XXXVII

Jones and Vaughan, Inc Ill

Lederle Laboratories XIII, XIV, XV, XVI, XXI,

Insert, XXXVIII, XXXIX, LXIV, LXXII, LXXV
Eli Lilly & Company XXXVI, Front Cover

Mayrand, Inc LIX

Medical-Dental Credit Bureau LXIX

Merck, Sharp & Dohme Second Cover, XLVI

Monarch Elevator and Machine Co LXX

Mutual of Omaha LVIII

Parke, Davis & Co XXIX, Third Cover

Physicians Casualty Association

Physicians Health Association LXX

Physicians Products Company Insert

Pinebluff Sanitarium I

P. Lorillard Company (Kent Cigarettes) XLIV

A. H. Robin Company X, XI, XXVI, XXVII, Insert
J. B. Roerig & Company XLV, LVII

Saint Albans Sanatorium LXXII

Sandoz Pharmaceuticals, Inc XVII

G. D. Searle & Co XLI

Smith-Dorsey Company XX, XXXI, L

Smith-Kline & French Laboratories 4th Cover

E. R. Squibbs and Sons XXXII, XLII, LVI

St. Paul Fire and Marine Insurance LXXIV

Tucker Hospital LXIX

The Upjohn Company XVIII, XIX

WachteFs Incorporated Reading

Wallace Laboratories ..... -IV, Insert, V, XXXV

Wesson Oil and Snowdrift

Sales Company XXII, XXIII

Winchester Surgical Supply Co.

Winchester-Ritch Co I

Winthrop Laboratories VI, VII, XLVIII

LV, LXVIII

3 -dimensional
support for older

patients

BOLSTERS... ▲ tissue metabolism
▲ interest, vitality
A failing nutrition

1 small capsule

.1.

every morning

EVRESTIN

®

Geriatric Vitamins-Minerals-Hormones-d-Amphetamine Lederle

Each capsule contains: Ethinyl Estradiol 0.01 mg. ■ Methyl
Testosterone 2.5 mg. • d-Amphetamine Sulfate 2.5 mg. • Vitamin
A (Acetate) 5,000 U.S. P. Units • Vitamin D 500 U.S. P. Units •
Vitamin B,2 with AUTRINIC® Intrinsic Factor Concentrate 1 15
U.S. P. Unit (Oral) • Thiamine Mononitrate (B,) 5 mg. • Ribo-
flavin (B2) 5 mg. • Niacinamide 15 mg. • Pyridoxine HCI (B,)
0.5 mg. • Calcium Pantothenate 5 mg. • Choline Bitartrate
25 mg. • Inositol 25 mg. • Ascorbic Acid (C) as Calcium AscorbaU

50 mg. • l-Lysine Monohydrochloride 25 mg. • Vitamin E
(Tocopherol Acid Succinate) 10 Int. Units • Rutin 12.5 mg. •
Ferrous Fumarate (Elemental iron, 10 mg.) 30.4 mg. • Iodine
(as Kl) 0.1 mg. • Calcium (as CaHP04) 35 mg. • Phosphorus (as
CaHP0a) 27 mg. • Fluorine (as CaF2) 0.1 mg. • Copper (as CuO)
1 mg. • Potassium (as K2S0.,) 5 mg. • Manganese (as MnCy
1 mg. • Zinc (as ZnO) 0.5 mg. • Magnesium (MgO) 1 mg. • Boron
(as Na2B40,.10H20) 0.1 mg. Bottles of 100, 1000.

LEDERLE LABORATORIES, a Division of AMERICAN CYANAMID COMPANY, Pearl River, New York

4,860 CULTURES...
74% SENSITIVE TO

In a study of the sensitivity of various clinically important bacteria to six
common antibacterial substances, Goodier and Parry1 report "... a greater
proportion of the individual strains within the various genera sensitive to
chloramphenicol."

Numerous other studies draw attention to the continuing sensitivity of
stubborn pathogens to CHLOROMYCETIN.2"8 For example, Modarress and
co-workers observe: "The versatile chloramphenicol was useful each year."2
Petersdorf and associates3 state: "There has been no increase in resistance
to chloramphenicol . . . during the past three years."

CHLOROMYCETIN (chloramphenicol, Parke-Davis) is available in various forms,
including Kapseals® of 250 mg., in bottles of 16 and 100.

CHLOROMYCETIN is a potent therapeutic agent and, because certain blood dys-
crasias have been associated with its administration, it should not be used indis-
criminately or for minor infections. Furthermore, as with certain other drugs,
adequate blood studies should be made when the patient requires prolonged or
intermittent therapy.

References: (1) Goodier, T. E.W., & Parry, W. R.: Lancet 1:356, 1959. (2) Modarress, Y;
Ryan, R. J., & Francis, Sr. C: /. M. Soc. New Jersey 57:168, 1960. (3) Petersdorf, R. C,
et al: Arch. Int. Med. 105:398, 1960. (4) Rebhan, A. W, & Edwards, H. E.: Canad.
M.A.J. 82:513, 1960. (5) Bauer, A. W.; Perry, D. M., & Kirby, W. M. M.: J.A.M.A.
173:475, 1960. (6) Olarte, J., & de la Torre,' J. A.: Am. J. Trop. Med. 8:324, 1959.
(7) Berle, B. B., et al: New York J. Med. 59:2383, 1959. (8) Fisher, M. W: Arch. Int.
Med. 105:413, 1960. ••••»

PARKE, DAVIS & COMPANY

Detroit 32, Michigan

PARKE-DAVIS

(chloramphenicol, Parke-Davis)

IN VITRO SENSITIVITY OF 4,860 GRAM-POSITIVE AND GRAM-NEGATIVE
PATHOGENS TO CHLOROMYCETIN AND TO FIVE OTHER ANTIBACTERIALS*

CHLOROMYCETIN 74%

Antibacterial A 61%

Antibacterial B 56%

Antibacterial C 55%

Antibacterial D 52%

Antibacterial E 23%

'Adapted from Goodier & Parry'

\

to relieve

either accompanying or causing somatic distress

- ri—iMnii /

advantages you can expect to see with

Stelazine

brand of trifluoperazine

• Prompt control of the underlying anxiety. Beneficial effects are often seen within 24-48 hours.

• Amelioration of somatic symptoms. Marx1 reported from his study of 43 office patients that
'Stelazine' "appeared to be effective tor patients whose anxiety was associated with organic— as
well as functional disorders."

• Freedom from lethargy and drowsiness. Winkelman2 observed that 'Stelazine' "produces a
state approaching ataraxia without sedation which is unattainable with currently available neuro-
leptic agents; its freedom from lethargy and drowsiness makes ['Stelazine'] extremely well accepted
by patients."

Optimal dosas^e: 2-4 mo. daily. Available as 1 mg. and 2 mg. tablets, in bottles of 50 and 500.

N.B.! For further information on dosage, side effects, cautions and contraindications, see available comprehensive
literature, Physicians' Desk Reference, or your S.K.F. representative. Full information is also on file with your pharmacist.

SMITH
KLINE £f
FRENCH

1. Marx. F.J., in Trifluoperazine: Further Clinical and Laboratory Studies, Philadelphia, Lea & Febigtr, 1959. P $9

2. Wmktlman, N.W.. Jr.: ibid., p. "8.

NORTH CAROLINA

IN THIS ISSUE:

INDEX TO VOLUME 21

now

PulvuEes®

Ilosone

. . .in a more acid-stable form

RECEIVED

■ DIVISION OF

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ELI LILLY AND COMPANY • INDIANAPOLIS 6, INDIANA, U.S.A.

Sfay

Table of Contents, Page II

CLINICAL REMISSION

INA"PROBLEM"ARTHRITIC

J^f3^ A 54-year-old diabetic

wth four-year h.story of arthritis was started on Decadron, 0.75 mg /
day, to control severe symptoms. After a year of therapy with 0.5 to
L5 mg. dady doses of Decadron, she has had no side effects and dia-
betes has not been exacerbated, ^jsjn^hj^ajjejnis^ipn *

Zs^Zfrizr rhedu,e: ,he **- a-d — - — «•«*- -v
on « oEcflDRO;:rr:::rzir;rc:.,i:,on °EcflDR0N is avai,abie ,o *-*-

Sharp & Dohme.

•Fronia clinical investigator's report Jo Merck

Decadron

TREATS MORE PATIENTS MORE EFFECTIVELY

,,'-"\

\S

gJS"£»« :

^?

«3?

<;

s»a

•S

fi

119 (

December. l(J<iO

ADVERTISEMENTS

A Sanitarium for Rest Under Medical Supervision, and
and Mental Diseases, Alcoholism and Drug

Treatment of Nervous
Addiction,

The Pinehluff Sanitarium is situated in the sandhills of North Carolina in a 60-acre park
of lone pines. It is located on U. S. Route 1, six miles south of Pinehurst and Southern
Pines. This section is unexcelled for its healthful climate.

Ample facilities are afforded for recreational and occupational therapy, particularly out-
of-doors.

Special stress is laid on psychotherapy. An effort is made to
an understanding of his problems and by adjustment to his
modification of personality traits to effect a cure or improvement i
physicians and a limited number of patients afford individual treat

For further information write:

The Pinebluff Sanitarium, Pinebiuff, N. c.

help the patient arrive at
personality difficulties or
the disease. Two resident
tment in each case.

Malcolm D. Kemp, M.D.

Medical Director

FURNITURE, SCIENTIFIC EQUIPMENT, INSTRUMENTS, LABORA-
TORY EQUIPMENT AND SUPPLIES, ORTHOPAEDIC APPLIANCES,

FRACTURE EQUIPMENT, SPLINTS
AND SUPPLIES.

Whenever you need a more derailed electrocardiogram you
switch the EK-1 1 1 from the standard 25mm per second to
50mm. This double speed enlarges horizontal dimensions of
the record end rapid deflections can be more easily studied.
In effect vou have a "close-up".

Weight of the unit is just 22 Vi lbs., yet the EK-1 11 uses
easy-to-read standard-size record paper.

The EK-1 1 1 top-loading paper-drive elimates tedious thread-
ing. Newly designed galvanometer and rigid single-tube stylus
insures even greater record clarity and accuracy.

.-■■v'""

BURDICK dual-speed EK-1 11

Why not write for descriptive material, or ask our represen-
tative for a demonstration of this NEW BURDICK?

We are proud to present this NEW Dual-Speed EK-1 11, and
invite your inspection.

Distributors of KNOWN BRANDS of PROVEN QUALITY

WINCHESTER

"CAROLINAS' HOUSE OF SERVICE"

Winchester Surgical Supply Co.
119 East 7th Street Charlotte, N. C.

Winchester-Ritch Surgical Co.
421 West Smith St. Greensboro, N. C

II

NORTH CAROLINA MEDICAL JOURNAL

December, 1960

North Carolina Medical Journal

Official Organ of
The Medical Society of the State of North Carolina

VOLUMR 21

No. 12

December, 1960

76 CENTS A COPY
$6.00 » i S..VK

CONTENT

Original Articles

Esophageal Emergencies — Frederick H. Tay-
lor, M.D., Paul W. Sanger, M.D., Francis
Robicsek, M.D., and Terry Rees, M.D. . . . 529

Outbreak of Waterborne Disease in a City
School— Arthur S. Chesson, Jr., M.D. ... 538

An Outbreak of Unusual Waterborne Illness in
Wayne Count y — Epidemiologic Aspects —
Jacob Koomen, Jr., M.D., M.P.H., Elizabeth
A. Zacha, R.N., William J. Stephenson, M.S.
and Arthur S. Chesson, Jr., M.D., M.P.H. . . 540

Cardiac Fibroma of the Interventricular Sep-
tum in a Newborn Infant: A Case Report —
Dan P. Boyette, M.D., and J. H. Smith Fou-
shee, M.D 544

Current Trends in the Use of Monoamine Oxi-
dase Inhibitors in Depression — Arthur J.
Prange, Jr., M.D 546

The Ocular Manifestations of Congenital Tox-
oplasmosis in Five out of 680 Cases of
Mental Deficiency Examined in a State In-
stitution for Mentally Retarded Children —
Frederick Edward Kratter, M.D 548

Medical Treatment of Glaucoma — Alan David-
son, M.D 551

Report from the Duke University Poison Con-
trol Center
Arsenic Poisoning — Jay M. Arena, M.D. . . . 553

President's Message

A Mid-Year Report — Amos N. Johnson, M.D. . 558

Correspondence

559

Bulletin Board

Coming Meetings 562

News Notes from the Bowman Gray School

of Medicine '. ... 562

News Notes from the University of North

Carolina School of Medicine 563

News Notes from the Duke University Med-
ical Center 564

County Societies 565

Forsyth County Cancer Symposium .... 565

North Carolina Radiological Society .... 565

Pediatric Research Institute 565

Announcements 566

Book Reviews

570

The Month in Washington

572

In Memoriam

Editorials

Post-election Reflections 555

More About Medical Research 556

Medical Care for Older People 556

The Harper's Supplement 557

The North Carolina Medical Journal Changes

Printers 557

Index to Volume 21

573

Classified Advertisements

569

Index to Advertisers
lix

Entered as second-class matter January 2. 1940, at the Post Office at Winston-Salem. North Carolina, under the Act of
Ausrust 24. 19)2, Copyright 1960 by the Medical Society of the State of North Carolina.

^

®

SYRUP OF CHLORAL HYDRATE

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OF TASTE RESISTANCE TO CHLORAL-HYDRATE

10 Grains (U.S. P. Dose) of palatable lime flavored
chloral-hydrate syrup in each teaspoonful

RAPID SEDATION WITHOUT HANGOVER

JONES and VAUGHAN, Inc. Richmond 26

, VA.

Wm3£.

oF ORAU

K.P.G. - 400

400,000 Units Potassium Penicillin
G Buffered, in each yellow, scored
tablet.

HONEY-CILLIN 300'

300,000 Units Buffered Penicillin G
in each 5 cc. Honey flavor. Yellow
color. 60 cc. size bottles.

HONEY-CILUN 400'

f 400,000 Units Buffered Penicillin G
■ in each 5 cc. Honey-Cherry flavor.
Red color. 60 cc. size bottles.

FRIFONACIL-250 LIQUID

Triple sulfas 0.5 Gm., Buffered Peni-
cillin G, 250,000 units in each
5 cc. Strawberry flavored, liquid.

TRIFONACIL-250 TABLETS

Triple sulfas 0.5 Gm., Buffered Peni-
5 cillin G, 250,000 units in each
scored, pink tablet.

/Samples and .
/ literature v
i gladly sent a
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hi rrolJ L LnJ U r> \J A /ru / n z T c d c d . , a r. mi on i w i a

fApOUNGING-

SPBCIFIGALLY FOR

INFECTIONS DUE TO
'RESISTANT" STAPHYLOCOCCI

AN ENTIRELY NEW SYNTHETIC
"STAPH-CIDAL" PENICILLIN

Staphcillin

I sodium dimethoxyphenyl penicillin
1 FOR INJECTION

LINIQUE-BECAUSE IT
RETAINS ANTIBACTERIAL
ACTIVITY IN THE PRESENCE OF
STAPHYLOCOCCAL PENICILLINASE
WHICH INACTIVATES
OTHER PENICILLINS

.

Official Package Circular
November, 1960

STAPHCILLIN™

(sodium dimelhoxy phenyl penicillin)
For Injection
DESCRIPTION

Staphcillin is a unique new synthetic parenteral penicillin produced
by Bristol Laboratories for the specific treatment of staphylococcal
infections due to resistant organisms. lis uniqueness resides in ils
property of resisting inactivation by staphylococcal penicillinase. It is
active against strains of staphylococci which arc resistant to other
penicillins.

Each dry filled vial contains: 1 Gni. Staphcillin (sodium dimethoxy-
phenyl penicillin), equivalent to 9011 nig. dimethoxyphenyl penicillin
activity.

INDICATIONS

Staphcillin is recommended as specific therapy only in infections
due to strains of staphylococci resistant to other penicillins, e.g.:

Skin and soft tissue injections: cellulitis, wound infections, car-
buncles, pyoderma, furunculosis, lymphangitis and lymphadenitis.

Respiratory injections: staphylococcal lobar or bronchopneumonia,
and lung abscesses combined with indicated surgical treatment.

Other infections: staphylococcal septicemia, bacteremia, acute or
subacute endocarditis, acute osteomyelitis and enterocolitis.

Infections due to penicillin-sensitive staphylococci, streptococci, pneu-
inococci and go no cocci should be treated with Syncillur* or parenteral
penicillin G rather than Staphcillin. Treponemal infections should
be treated with parenteral penicillin G.

DOSAGE AND ADMINISTRATION

Staphcillin is well tolerated when given by deep intragluleal or intra-
venous injection.

As is the case with other antibiotics, the duration of therapy should be
determined by the clinical and bacteriological response of the patient.
Therapy should be continued for at least '18 hours after the patient has
become afebrile, asymptomatic and cultures arc negative. The usual
duration has been 5-7 days.

Intramuscular route: The usual adult dose is 1 Gm. every 4 or G hours.
Infants' and children's dosage is 25 nig. per Kg. (approximately 12 mg.
per pound) every 6 hours.

route: 1 Gm,

at the rate of 10 n

iery 6 hours using 50 ml
I. per minute.

of sterile saline

"Warning: Solutions of STAPHCILLIN and kanamycin should not be
mixed, as they rapidly inactivate each other. Data on the results of
mixing Staphcillin with other antibiotics arc being accumulated.

DIRECTIONS FOR RECONSTITUTION

Add 1.5 ml. sterile distilled water or normal saline to a 1 Gm. vial and
shake vigorously. Withdraw the clear, reconstituted solution (2.0 ml,)
into a syringe and inject. The reconstituted solution contains 500 mg.
of Staphcillin per ml. Reconstituted solutions are stable for 24 hours
under refrigeration.

For intravenous use, dilute the reconstituted dose in 50 ml. of sterile
saline and inject at the rate of 10 ml. per minute.

•Till, ilslcnirnl lupuutlei llml In Ihf Officiil Putt it r Circular, ilolcj Strireinlirr onil/of Otkibrr. 1%0,

( continued)

Official Package Circular {•

MICROBIOLOGICAL AND PHARMACOLOGICAL
PROPERTIES

hi vitro studies show that Staphcillin is a bactericidal penicillin
with activity against staphylococci resistant to penicillin G. Strains of
staphylococci so far tested have been sensitive to Staphcillin in vitro
at concentrations of 1-6 meg. per ml. These levels are readily attained
in the blood and tissues by administration of Staphcillin at the
recommended dosage. This unique attribute is probably due to the
fact that Staphcillin is stable in the presence of staphylococcal peni-
cillinase. STAPHCILLIN also resists degradation by B. cereus penicil-
linase. The antoniierobial spectrum of Staphcillin with regard to
other microorganisms is qualitatively similar to that of penicillin G;
but considerably higher concentrations of STAPHCILLIN are required
for bactericidal activity than is the case with penicillin G.

Staphcillin is rapidly absorbed after intramuscular injection. Peak
blood levels (6-10 mcg./ml. on the average after a 1.0 Gin. dose) are
attained within 1 hour; and then progressively decline to less than
1 meg. over a 4 to 6 hour period. It is poorly absorbed from the gastro-
intestinal tract. Staphcillin is rapidly excreted by the kidney.

As shown by animal studies, Staphcillin is readily distributed in body
tissues after intramuscular injection. Of the tissues studied, highest
concentrations are reached in the kidney, liver, heart and lung in that
order; the spleen and muscles show lower concentrations of the anti-
biotic. Staphcillin diffuses into human pleural and prostatic fluids,
but its diffusion into the spinal fluid has not yet been completely
studied. However, one patient with meningitis showed a significant
concentration in his spinal fluid while on Staphcillin therapy.

Toxicity studies with Staphcillin and penicillin G in animals show
that they have approximately the same low order of toxicity.

Certain staphylococci can he made resistant to Staphcillin in the
laboratory, but this resistance is not related to their penicillinase pro-
duction. During the clinical trials, no STAPHCiLLiN-resistant strains of
staphylococci were observed or developed; the possibility of the emer-
gence of such strains in the clinical setting awaits further observation.

PRECAUTIONS

During the clinical trials, several mild skin reactions, e.g., itching,
papular eruption and erythema were observed both during and after
discontinuance of Staphcillin therapy. Patients with histories of hay
fever, asthma, urticaria and previous sensitivity to penicillin are more
likely to react adversely to the penicillins. It is important that the
possibility of penicillin anaphylaxis be kept in mind. Epinephrine and
the usual adjuvants (antihistamines, corticosteroids) should be avail-
able for emergency treatment. Because of the resistance of STAPHCILLIN
to destruction by penicillinase, parenteral B. cereus penicillinase may
not be effective for the treatment of allergic reactions. Information
with regard to cross-allergen icity between penicillin G, penicillin V,
phenethicillin (Syncillin) and Staphcillin is not available at present.
If superinfection due to Gram-negative organisms or fungi occurs
during Staphcillin therapy, appropriate measures should be taken.

SUPPLY

List 79502 - 1.0 Gm. dry filled vial.

BRISTOL LABORATORIES • SYRACUSE, NEW YORK

Division of Bristol-Myers Company

In the presence of staphylococcal
penicillinase, Staphcillin remained active
and retained ils antibacterial action.
By contrast, penicillin G was rapidly
destroyed in the same period n( time.
(After Gourevitck et al., to be published)

Specifically for "resistant" staph...

Staphcillin

I sodium dimetlioxyphenyl penicillin
I FOR INJECTION

The failure of staphylococcal infections to respond to penicillin therapy is attributed to
the penicillin-destroying enzyme, penicillinase, produced by the invading staphylococcus.

Unlike other penicillins:

1 Staphcillin is effective because it retains its antibacterial activity despite the pres-
ence of staphylococcal penicillinase.

Z The clinical effectiveness of Staphcillin has been confirmed by dramatic results in
a wide variety of infections due to "resistant" staphylococci, many of which were serious
and life-threatening.

Like other penicillins:

Staphcillin has no significant systemic toxicity. It is well tolerated locally, and
pain or irritation at the injection site is comparable to that following the injection of
penicillin G. In occasional cases, typical penicillin reactions may be experienced.

PROFESSIONAL INFORMATION SERVICE - The attached Official Package Circular provides com-
plete information on ihe indications, dosage, and precautions for the use of Staphcillin. If yon desire
additional information concerning clinical experiences with Staphcillin, the Medical Department of
Bristol Laboratories is at your service. Yon may direct your inquiries via collect li-lcplionc call to New York,
PLaza 7-7061, or by mail to Medical Department, Bristol Laboratories, 630 Fifth Ave., N.Y 20, N.Y.

~*

BRISTOL LABORATORIES ■ SYRACUSE, NEW YORK

Division of Bristol-Myers Company

V

&

> '^v

JL ij*t

1*JV

vXS

ACUTE BRONCHITIS

Illustrative
case summary
:om the files of
il Laboratories'
al Department

SYNCILLIN

250 mg. t.i.d. - 6 days

H.F. 45-year-old white female. First seen on
Aug. 24, 1959 with acute bronchitis of 3 days'
duration. Culture of the sputum revealed alpha"
hemolytic streptococci. A 250 mg. SYNCILLIN
tablet was administered 3 times daily. Another
sputum culture taken on Aug. 27 showed no growth
On Aug. 30, the patient appeared much improved
and SYNCILLIN was discontinued.
Recovery uneventful.

\^\

THE ORIGINAL phenethicillin

(phenoxyethyl penicillin potassium)

tRST SYNTHESIZED AND MADE AVAILABLE BY BRISTOL MB OR MWIES

dosage form to meet the individual requirements of patients of all ages in home, office, clinic, and hospital ■
Incillm Tablets -250 mg. (400,000 units) . . . Syncillin Tablets- 125 mg. (200 000 units)
Incilhn for Oral Solution -60 ml. bottles -when reconstituted, 125 mg. (200,000 units) per 5 ml

Incillm Tablets-250 mg. (400,000 units) ...Syncillin Tablets- 125 mg. (200 000 units)
Incilhn for Oral Solution -60 ml. bottles -when reconstituted, 125 mg. (200,000 units) per 5 ml
hicillin Pediatric Drops -1.5 Gm. bottles. Calibrated dropper delivers 125 mg. (200 000 units)

eptococcal infections should be treated for at least 10 days to prevent the development of rheumatic fever
m as prophylaxis against bacterial endocarditis in susceptible patients.

C jnplete information on indications,

tetSS&£*££E ^ BRIST°L LAB0RAT0RIES- Div- of Bristol-Myers Co. , SYRACUSE. N.Y. fc^™

Bone section: erosion
and purulent exudate

V

H

it

i

«t

Therapeutic
confidence

Panalba is effective against
more than 30 commonly
encountered pathogens
including ubiquitous
staphylococci. Right from
the start, prescribing it gives
you a high degree of
assurance of obtaining the
desired anti-infective action
in this as in a wide variety
of bacterial diseases.

Supplied: Capsules, each
containing Panmycin*
Phosphate (tetracycline
phosphate complex) ,
equivalent to 250 mg.
tetracycline hydrochloride,
and 125 mg. Albamycin,*
as novobiocin sodium, in
bottles of 16 and 100.

•Trademark, Reg. U. S. Pat. Off.

The Upjohn Company
Kalamazoo, Michigan

Panalba

*

xT*

your broad-spectrum

,.:u:_^- _r r.

\ 111 NORTH CAROLINA MEDICAL JOURNAL December, 1960

Medical Society of the State of North Carolina

OFFICERS — 1960

President — Amos Neill Johnson, M.D., Garland

President Elect — Claude B. Squires, M.D., 225 Hawthorne Lane, Charlotte
Past President — John C. Reece, M.D., Grace Hospital, Morganton
First Vice-President — Theodore S. Raiford, M.D., Doctors Building, Asheville
Second Vice-President — Charles T. Wilkinson, M.D., Wake Forest
Secretary — John S. Rhodes, M.D., 700 West Morgan Street, Raleigh
Executive Director — Mr. James T. Barnes, 203 Capital Club Building, Raleigh
The President, Secretary and Executive Director are members ex-officio

of all committees
Speaker-House of Delegates — Donald B. Koonce, M.D., 408 N. 11th St., Wilmington
Vice-Speaker-House of Delegates — E. W. Schoenheit, M.D., 46 Haywood St., Asheville

COUNCILORS — 1958 - 1961

First District — T. P. Brinn, M.D., 118 W. Market Street, Hertford

Vice Councilor — Q. E. Cooke, M.D., Murfreesboro
Second District — Lynwood E. Williams, M.D., Kinston Clinic, Kinston

Vice Councilor — Ernest W. Larkin, Jr., M.D., 211 N. Market St., Washington
Third District — Dewey H. Bridger, M.D., Bladenboro

Vice Councilor — William A. Greene, M.D., 104 E. Commerce St., Whiteville
Fourth District — Edgar T. Beddingfield, Jr., M.D., P.O. Box 137, Stantonsburg

Vice Councilor — Donnie H. Jones, M.D., Box 67, Princeton
Fifth District — Ralph B. Garrison, M.D., 222 N. Main Street, Hamlet

Vice Councilor — Harold A. Peck, M.D., Moore County Hospital, Pinehurst
Sixth District — George W. Paschal, Jr., M.D., 1110 Wake Forest Rd., Raleigh

Vice Councilor— Rives W. Taylor, M.D., P.O. Box 1191, Oxford
Seventh District —

Vice Councilor — Edward S. Bivens, M.D., Stanly County Hospital, Albemarle
Eighth District— Merle D. Bonner, M.D., 1023 N. Elm Street, Greensboro

Vice Councilor — Harry L. Johnson, M.D., P.O. Box 530, Elkin
Ninth District — Thomas Lynch Murphy, M.D., 116 Rutherford St., Salisbury

Vice Councilor — Paul McNeely Deaton, M.D., 766 Hartness St., Statesville
Tenth District — William A. Sams, M.D., Main Street, Marshall

Vice Councilor — W. Otis Duck, M.D., Drawer 517, Mars Hill

DELEGATES TO THE AMERICAN MEDICAL ASSOCIATION

Elias S. Faison, M.D., 1012 Kings Drive, Charlotte

C. F. Strosnider, M.D., 111 E. Chestnut Street, Goldsboro

Millard D. Hill, M.D., 15 W. Hargett Street, Raleigh

William F. Hollister, M.D., (Alternate), Pinehurst Surgical Clinic, Pinehurst

Joseph F. McGowan, M.D., (Alternate), 29 Market Street, Asheville

Wm. McN. Nicholson, M.D., (Alternate), Duke Hospital, Durham

SECTION CHAIRMEN 1959-1960 "■

General Practice of Medicine — Julius Sader, M.D., 205 East Main Street, Brevard • P

Internal Medicine — Walter Spaeth, M.D., 116 South Road, Elizabeth City
Ophthalmology and Otolaryngology — Charles W. Tillett, Jr., M.D., 1511 Scott

Avenue, Charlotte :r of

Surgery — James E. Davis, M.D., 1200 Broad Street, Durham

Pediatrics — William W. Farley, M.D., 903 West Peace Street, Raleigh "-n

Obstetrics & Gynecology — H. Fleming Fuller, M.D., Kinston Clinic, Kinston

Public Health and Education— ISA C. Grant, M.D., Box 949, Raleigh ■*

Neurology & Psychiatry — Myron G. Sandifer, M.D., N. C. Memorial Hospital, ,„

Chapel Hill
Radiology — Isadore Meschan, M.D., Bowman Gray School of Medicine, :-

Winston-Salem I.

Pathology — Roger W. Morrison, M.D., 65 Sunset Parkway, Asheville

Anesthesia — Charles E. Whitcher, M.D., Route 1, Pfafftown $

Orthopedics & Traumatology — Chalmers R. Carr, M.D., 1822 Brunswick Avenue,

Charlotte [;,

Student AMA Chapters — Mr. John Feagin, Duke University School of Medicine,

Durham •';:[

1

;..,,

■■■■■■■

Dosage: 2 Tablets B.I.D. (A.M. & P.M.)

H

mi

■

in premenstrual tension

:o Bromth

only
treats the whole syndrome

'(Vi.:;y*£i*^-^;^>~"r-'

It was the introduction of neo Bromth several years ago that created such widespread
interest in the premenstrual syndrome — because of neo Bromth's specific ability
to prevent the development of the condition in the first place.

The action of neo Bromth is not limited merely to control of abnormal water retention,
or of nervousness, or of pain — or any other single or several of the multiple
manifestations characteristic of premenstrual tension, neo Bromth effectively controls
the whole syndrome.

neo Bromth is also completely free from the undesirable side effects associated with
such limited-action therapy as ammonium chloride, hormones, tranquilizers and potent
diuretics, neo Bromth has continued to prove to be the safest — as well as the most
effective — treatment for premenstrual tension.

Each 80 mg. tablet contains 50 mg. Pamabrom, and 30 mg. pyrilamine maleate.
Dosage is 2 tablets twice daily (morning and night) beginning 5 to 7 days before
menstruation. Discontinue when the flow starts.

BRAYTEN PHARMACEUTICAL COMPANY . Chattanooga 9, Tennessee

CB

FIORINAL

relieves pain,

muscle spasm,
nervous tension

rapid action • non-narcotic • economical

"We have found caffeine, used in combination with acetylsalicylic acid, acetophenetidin,

and isobutylallylbarbituric acid, [Fiorinal] to be one of the most

effective medicaments for the symptomatic treatment of headache due to tension."

Friedman, A. P., and Merriii, H. H.: J.A.M.A. 763:1111 (Mar. 30) 1957.

\

Lvailable: Fiorinal Tablets and
'ew Form — Fiorinal Capsules

Each contains: Sandoptal (Allylbarbituric Arid N.F. X)

50 ing, (3/4 gr. I. caffeine 40 mg. (2/3 gr. I, acetylsalicylic acid

200 nig. 1 3 gr. I , acetophenetidin 130 mg. 1 2 gr. I .

December, 1960

ADVERTISEMENTS

XI

SAUNDERS BOOKS

New!— A Manual and Atlas for the General Surgeon

Marble -The Hand

This unusual book is aimed at the needs of the gen-
eral practitioner, general surgeon and industrial
physician — the men who see hand injuries first. Full
page plates and explicit text give you quick instruc-
tions on treating every type of hand injury you are
likely to see- — from lacerations and puncture wounds
to fractures and crushing injuries.
Extensive covetage is given to closed injuries of the
hand and their management: contusions, swellings,

avulsion of tendons, burns, sprains, frostbite, frac-
tures and dislocations. Open injuries are then con^
sidered. Beautiful drawings illustrate methods of
tendon advancement; repair of lacerated nerve; skin-
graft; repair of traumatic amputation of finger; etc.
Separate chapters cover: splinting; infections; and
tumors of the hand.

By Henry C. Marble, M.D., F.A.C.S.. Consulting Surgeon to the
Massachusetts General Hospital. 207 pages, 6Li"x934", illustrated.
57.00. Ready January!

New!— Solid Information on Every Phase of Modern Hypnotic Practice

Meares-A System of Medical Hypnosis

Here is sound advice on how to apply hypnosis safely
and effectively in your everyday practice. Dr. Meares
gives step-by-step instructions for each method of
induction: by direct stare; by suggestions for relax-
ation; by arm Ievitation; etc. He gives practical help
on choosing the right method of induction for a par-
ticular case.

You'll find suggestions for clinical use of hypnosis in
relief of pain and insomnia; as an aid to diagnosis;

and as an anesthetic agent. The value of hypnosis in
obstetrics and delivery is clearly discussed — with
methods, problems and complications pointed up in
rich detail. There are useful hints on applying hyp-
nosis in the treatment of various gynecologic dis-
orders, chronic illness, psychogenetic obesity, and
alcoholism.

By AlNSLIE MEARES, M.D., D.M.P., Melbourne, Australia. Presi-
dent, International Society for Clinical and Experimental Hypnosis.
484 pages. 6"x9V4". About 510.00. New — Just Ready!

New!— Sound Advice on Meeting Hundreds of Surgical Hazards

Artz & Hardy -Complications in Surgery & Their Management

With the aid of 69 authorities, the editors have com-
piled a complete text on the pitfalls of surgery —
from preoperative preparation thtough post-opera-
tive convalescence. The authors cover general com-
plications that may occut in almost any type of
surgery, such as infections, wound dehiscence, shock,
transfusion reactions, etc. Next, the management of
special problems of severe pain, anesthetic compli-
cations, nutritional problems and emotional crises is
clearly described. More than half of the book is de-

voted to the specific complications that arise in par-
ticular surgical operations.

Comprehensive chapters detail complications of:
antibiotic therapy — radiation therapy — pulmonary
resection — splenectomy — appendectomy — pediatric
surgery — hernia repair — surgery of the breast —
common fractures — burns — etc.

Edited by Curtis P. ARTZ, M.D., F.A.C.S.. Associate Professor of
Surgery; and James D. Hardy. M.D.. F.A.C.S., Professor and Chair-
man of the Department of Surgery, University of Mississippi. With
Conttibutions by 69 other Authorities. 1075 pages, 7"xl0", with
271 illustrations. 523.00. New!

Order Today from W. B. SAUNDERS COMPANY

West Washington Square Philadelphia 5

Please send and charge my account:

□ Marble— The Hand: A Manual & Atlas for the General Surgeon, $7.00. (Send when ready)

□ Meares— A System of Medical Hypnosis, about $10.00.

□ Artz & Hardy— Complications in Surgery & Their Management, $23.00.

Name _____

Address .

In over five years^

Proven

in more than 750 published clinical studies

Effective

for relief of anxiety and tension

Outstandingly Safe

1 simple dosage schedule produces rapid, reliable
tr;

no cumulative effects, thus no need for diffictdt
dosage readjustments

ranquilization without unpredictable excitation

9 n

•^ d

-\ does not produce ataxia, change in appetite or libido

4 does not produce depression, Parkinson-like symptoms,
jaundice or agranulocytosis

^ does not impair mental efficiency or normal behavior

Milt own

meprobamate (Wallace]

Usual dosage: One or two 400 mg. tablets t.i.d.
Supplied: 400 mg. scoicd tablets. 200 mg. sugar-coated tablets.
Also as MEPROTABS* — 400 mg. unmarked, coated tablets; and
as MF.i'ROSPAN®— 400 mg. and 200 mg. continuous release capsules.

W WALLACE LABORATORIES / Cninbury, N. J.

•traoe h»*K

of clinical use.

. . . for the tense and nervous patient

Despite the introduction in recent years of "new and different" tranquil-
izers, Miltown continues, quietly and steadfastly, to gain in acceptance.
Meprobamate (Miltown) is prescribed by the medical profession more than
any other tranquilizer in the world.

The reasons are not hard to find. Miltown is a known drug. Its few side
effects have been fully reported. There are no surprises in store for either
the patient or the physician.

NEW analgesic

Kills pain

(StfRvAS

"'.• '* to ~

"•«»', >£?*£«

.,:«'.''

,c-

stops tension

For neuralgias, dysmenorrhea, upper respiratory
distress, postsurgical conditions ... new compound
kills pain, stops tension, reduces fever— gives more
complete relief than other analgesics.

Soma Compound is an entirely new, totally dif-
ferent analgesic combination that contains three
drugs. First, Soma: a new type of analgesic that
has proved to be highly effective in relieving
both pain and tension.* Second, phenacetin:
a "standard" analgesic and antipyretic. Third,

caffeine: a safe, mild stimulant for elevation of
mood. As a result, the patient gets more complete
relief than he does with other analgesics.

Soma Compound is nonnarcotic and nonad-
dicting. It reduces pain perception without im-
pairing the natural defense reflexes.*

NEW NONNARCOTIC ANALGESIC

soma9 Compound

Composition: Soma (carisoprodol), 200 mg.;
phenacetin. 160 mg.; caffeine, 32 mg.
Dosage: 1 or 2 tablets q.i.d.
Supplied: Bottles of 50 apricot-colored,
scored tablets.

NEW FOR MORE SEVERE PAIN

soma" (Jompound codeine

BOOSTS THE EFFECTIVENESS OF CODEINE: Soma Compound boosts
the effectiveness of codeine. Therefore, only \\ grain of codeine phosphate
is supplied to relieve the more severe pain that usually requires Vz grain.

Composition: Same as Soma Compound plus Vi grain codeine phosphate.

Dosage: 1 or 2 tablets q.i.d.

Supplied: Bottles of 50 white, lozenge-shaped tablets; subject to Federal Narcotics Regulations.

Vf/WALLACE LABORATORIES • Cranbury, N. J.

'References available on request.

Diet or Drugs?

In the long term control of serum cholesterol,

dietary therapy can achieve the objective in the manner most

closely approximating physiological norm.

The long term control of elevated serum cholesterol through changes in the dietary
pattern of the patient puts nature's own process to work most effectively to achieve
the objectives of treatment. Here are the beneficial features of dietary therapy:

Offers a solution to the related problems of obesity.

Involves little or no added expense to the patient.

May be used with complete safety.

Produces no adverse side effects.

Preferable for the long-term management of a chronic condition.

Brings about reduction of serum cholesterol through physiological
processes, as yet not fully understood.

Does not usually generate new compounds in the blood,
thus helping the doctor make a more accurate analysis
of blood serum cholesterol.

Elevated serum cholesterol has now been linked
to an imbalance in the ratio of the type of fat
in the diet. Reductions in cholesterol levels have
been achieved repeatedly, both in medical re-
search and practice, through the control of

an appreciable percentage of saturated fat by
poly-unsaturated vegetable oil.

An important measure in achieving replace-
ment is the consistent use of poly-unsaturated
pure vegetable oil in food preparation in place

total calories and through the replacement of of saturated fat.

Free Wesson recipes for delicious main dishes, desserts and salad dressings are available

for your patients. Request quantity needed from The Wesson People, Dept. N, 210 Baronne S a^j

Poly-unsaturated Wesson is unsurpassed by any

readily available brand, where a vegetable (salad) oil is medically

recommended for a cholesterol depressant regimen.

*>.&>

Wesson is poly -unsaturated :. . never hydrogenated

More acceptable to patients. Wesson is preferred
for its supreme delicacy of flavor, increasing the
palatability of food without adding flavor of its own.

Uniformity you can depend on. Wesson has a poly-
unsaturated content better than 50%. Only the
lightest cottonseed oils of high iodine number are
selected for Wesson, and no significant variations
are permitted in the 22 exacting specifications
required before bottling.

Economy. Wesson is consistently priced lower than
the next largest seller.

y^*

WESSON'S IMPORTANT CONSTITUENTS

Wesson is 100% cottonseed oil... winterized and of selected quality

Linoleic acid glycerides (polyunsaturated) 50-55%

Oleic acid glycerides (mono-unsaturated 16-20%

Total unsaturated 70-75%

Palmitic, stearic and myristic glycerides (saturated) 25-30%

Phytosterol (Predominantly beta sitosterol) 0.3-0.5%

Total tocopherols 0.09-0.12%

Never hydrogenated — completely salt free

CHLOROMYCETIN

chloramphenicol, Parke-Davis
IN VITRO SENSITIVITY OF COAGULASE-POSITIVE STAPHYLOCOCCI TO CHLOROMYCETIN FROM 1955 TO 1959*

These sensiti\-ity tests were done by the disc method on 310 strains of coagulase-positive staphylococci. Strains were isolated from

patients seen in the emergency room. It should be noted that among inpatients, resistant strains were considerably more prevalent.

* Adapted from Bauer, A. W.j Perry, D. M., & Kirby, W M. M.: J.A.M.A. 173:475, 1960. iosso

CHLOROMYCETIN (chloramphenicol, Parke-Davis) is available in various forms, including Kapseals® of

250 mg., in bottles of 16 and 100.

CHLOROMYCETIN is a potent therapeutic agent and, because certain blood dyscrasias have been associated

with its administration, it should not be used indiscriminately or for minor
infections. Furthermore, as with certain other drugs, adequate blood studies
clnnnlrl hp mnrlp whpn the natifint rpnuires nrolonffed or intermittent therapy.

PARKE-DAVIS

for the patient who is

coughing his head off

in upper respiratory infections

®

HASACODE

^ Quiets the overactive cough reflex
sfj Relieves aches and fever
% Sedates the anxious patient
% Handy tablet form

COMPOSITION: Each tablet contains:

Acetylsalicylic Acid 2% grains

Acetophenetidin (Phenacetin) 2% grains

Phenobarbital % grain

Codeine Phosphate % grain

Hyoscyamus Alkaloids 0337 mg.

DOSE: One or two tablets every 3 or 4 hours, as
required. Not more than 8tablets should betaken
in 24 hours. WARNING: may be habit forming.

also HASACODE "STRONG"

Same formula as HASACODE, but with Y2 grain
codeine phosphate. For use where relief of pain
is the primary target. DOSE: As for HASACODE.

And for relief of less severe
type of respiratory infection :

HASAMAL®

Same formula as HASACODE, but without codeine
phosphate. DOSE: As for HASACODE.

SUPPLIED: All forms available in bottles of 100
and 500 tablets.

Charles C.

Haskell

& Company

Richmond, Virginia

XVIII

NORTH CAROLINA MEDICAL JOURNAL

December, I960

Give to the
school of your choice
through AMEF

American Medical Education Foundation

To train the doctors of tomorrow,
the nation's medical schools must have
your help today. It is a physician's unique
privilege and responsibility to replenish
his own ranks with men educated
to the highest possible standards.
Invest in the future health of the nation and
your profession. Send your check today!

535 North Dearborn Street
Chicago 10, Illinois

1

V

.

. 5

;i

with paregoric equivalent

Provides greater assurance of more comprehensive relief in
self -limiting diarrheas through the time-tested effectiveness of two
outstanding antidiarrheals— Donnagel and a paregoric equivalent.
Tastes good, too!

Each 30 cc. (1 fi. oz.) of Donnagel-PG Also available:

contains: ^■^'rrfiWfPlr'

Powdered opium U.S.P mg. B_kJiii||Xg^gjtt|iI||2ll^|n

(equivalent to paregoric 6 mi.) control of bacterial diarrheas.

Kaolin G.O Gm.

Pectin 142.8 mg. : ,:.._ ..=■■; _ the basic formula -

Natural belladonna alkaloids . ... - .-

hyoscyamine sulfate 0.1037 mg. when paregoric or an antibiotic is not

atropine sulfate 0.0194 mg. requited.

hyoscine hydrobromide 0.0065 mg.

Phenobarbital Cigr.) 16.2 mg.

Supplied: Pleasant-tasting banana fla- A. H. KUdIINo UU., INU.
vored suspension in bottles of 6 fl. oz. RICHMOND 20. VIRGINIA

*

M

What's she doing that's of medical interest?

he's drinking a glass of pure Florida
range juice. And that's important to
er physician for several reasons.

How your patients obtain their vita-
lins or any of the other nutrients found
1 citrus fruits is of great medical inter-
it— considering the fact there are so
lany wrong ways of doing it, so many
ubstitutes and imitations for the real
hing.

Actually, there's no better way for
his young lady to obtain her vitamin C
han by doing just what she is doing,

for there's no better source than oranges
and grapefruit ripened in the Florida
sunshine. There's no substitute for the
result of nature's own mysterious chem-
istry, flourishing in the warmth of this
luxurious peninsula.

An obvious truth, you might say, but
not so obvious to the parents of many
teen-agers.

We know that a tall glass of orange
juice is just about the best thing they
can reach for when they raid the refrig-
erator. We also know that if vou en-

courage this refreshing and healthful
habit among your young patients — and
for that matter, your patients of any age
— you'll be helping them to the finest
between-meals drink there is.

Nothing has ever matched the quality
of Florida citrus— watched over as it
is by a State Commission that enforces
the world's highest standards for quality
in fresh, frozen, canned or cartoned
citrus fruits and juices.

That's why the young lady's activiti'
are of medical interest.

* Florida Citrus Commission, Lakeland, Florida

NEW For the
multi-system disease

HYPERTENSION

l.M--::

TENSIN

Hydroflumethiazide • Reserpine . Protoveratrine A

g An integrated multi-therapeutic

antihypertensive, that combines in balanced pro-

In each salutensin Tablet: portions three clinically proven antihypertensives.

Saluron® (hydroflumethiazide) —

a saluretic-antihypertensive 50 me n i_

!?«.„„■- . i j L " Comprehensive information on dosage and precautions

Jteierpine — a tranquilizing drug with „ «.«i»»»«»™

peripheral vasorelaxant effects 0.125 mg. official package circular or available on request.

Protoveratrine A— a centrally mediated

vasoreIaxant 02ms- BRISTOL LABORATORIES • Syracuse, New York

acetylsalicylic acid (300 mg.) and chlormezanone (50 nig.)

rin

Tablets

a broad spectrum
non-narcotic analgesic

Trancoprin, a new analgesic, not only raises the pain perception threshold
but, through its chlormezanone component, also relaxes skeletal muscle spasm16
and quiets the psyche.2'35 7

The effectiveness of Trancoprin has been demonstrated clinically8 in a
number of patients with a wide variety of painful disorders ranging from
headache, dysmenorrhea and lumbago to arthritis and sciatica. In a series of
862 patients,8 Trancoprin brought excellent or good relief of pain to 88 per cent
of the group. In another series,9 Trancoprin was administered in an industrial
dispensary to 61 patients with headache, bursitis, neuritis or arthritis. The
excellent results obtained prompted the prediction that Trancoprin ". . . will
prove a valuable and safe drug for the industrial physician."9
Exceptionally Safe

No serious side effects have been encountered with Trancoprin. Of 923
patients treated with Trancoprin, only 22 (2.4 per cent) experienced any side
effects.89 In every instance, these reactions, which included temporary gastric
distress, weakness or sedation, were mild and easily reversed.
Indications

Trancoprin is recommended for more comprehensive control of the pain
complex (pain-*- tension-* spasm) in those disorders in which tension and
spasm are complicating factors, such as: headaches, including tension head-
aches / premenstrual tension and dysmenorrhea / low back pain, sciatica,
lumbago / musculoskeletal pain associated with strains or sprains, myositis'
fibrositis, bursitis, trauma, disc syndrome and myalgia / arthritis (rheumatoid
or hypertrophic) / torticollis / neuralgia.

Dosage

The usual adult dosage is 2 Trancoprin tablets three or four times daily
The dosage for children from 5 to 12 years of age is 1 tablet three or four times
daily. Trancoprin is so well tolerated that it may be taken on an empty stomach
for quickest effect. The relief of symptoms is apparent in from fifteen to thirty
minutes after administration and may last up to six hours or longer.
How Supplied

Each Trancoprin tablet contains 300 mg. (5 grains) of acetylsalicylic acid
and 50 mg. of chlormezanone [Trancopal* brand]. Bottles of 100 and 1000.

Trancoprin

non-narcotic analgesic

References. lUeNyseD.U: M. Times 87:1512. Nov.. 1959. 2. Cans, S. E, J. Indiana M. A. 52:1134 July 1959
Lo Tl n7 A", C"rrentJh^- «"■ ". J-»- I960. 4. Kearney. R. D, Current Therap. tf.s. 2:127 AprU

1960. 5. Lichtman, A. L.: Kentucky Acad. Cen. Pract. J. 4:28, Oct., 1958 6 Mullin W G fl„H F„l„n t \, a

££ n't Tr<Zrh°ct- im 7 Shanaphy' J F ^^™z££?£ZFZL£

fellxL <T n ^ed.cal Research. Winthrop Laboratories. 9. Hergesheimer. L. H, An evaluation of a musl

relaxant (Trancopal) alone and with aspirin (Trancoprin) in an industrial medical practice, to be submitted

LABORATORIES , New York 18, N. Y.

Trancoprin and Trancopal (brand of chlormezanone) trademarks reg. U. S. Pat. Off.

NEW PROTEIN
TISSUE BUHDilC

AGENT

FOR SIGNIFICANT ANABOLIC GAINS IN: ASTHENIA (UNDER-
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FRACTURES; OSTEOPOROSIS; AND IN OTHER CATABOLIC STATES

■ PROMOTES AND MAINTAINS POSITIVE NITROGEN BALANCE ■ HELPS
RESTORE APPETITE, STRENGTH, AND VIGOR ■ BUILDS FIRM, LEAN
MUSCULAR TISSUE ■ FAVORABLY INFLUENCES CALCIUM AND
PHOSPHORUS METABOLISM ■ PROMOTES A SENSE OF WELL-BEING

ADROYD PROVIDES HIGH ANABOLIC ACTIVITY -The tissue-building potential of
adroyd exceeds its androgenic action to the extent that masculinizing effects have not been
a problem in clinical use.* Other advantages of adroyd are: Neither estrogenic nor progesta-
tional. No significant fluid retention. Apparent freedom from nausea, vomiting, and other
gastrointestinal disturbances. Effective by the oral route.

See medical brochure, available to physicians, for details of administration and dosage.

Supplied: 10-mg. scored tablets, bottles of 30. «=76o DA RKE"D AV I S

'Reports to Department of Clinical Investigation, Parke, Davis & 1
Company, 1958 and 1959. poke, davis a com pa ny ■ Detroit 3 2 . m ic h ig« ..

"Well, I'll send the culture
to the lab, and we should
hear from Bacteriology in a
day or two. Now, how
shall we treat her cystitis
while we're waiting?"

"The chief usually orders azotrex. The azo dye

is an excellent urinary analgesic and the

sulfamethizole and tetracycline are likely to take care

of most of the bugs you find in the urinary tract.

If necessary, you can switch to something else after you get

the lab findings. But it probably won't be necessary,"

Each azotrex capsule contains: tetrex® (tetra-
cycline phosphate complex) equivalent to
tetracycline HCI activity... 125 mg.; sulfameth-
izole . . . 250 mg.; phenylazo-diamino:pyridine
HCI ... 50 mg. Supply: Bottles of 24 and 100.

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in 106-patient controlled study

(as re-ported in]. A. M.A., April 30, 1960)

"Particularly gratifying was the drug's [Soma's]
ability to relax muscular spasm, relieve pain, and
restore normal movement ... Its prompt action,
ability to provide objective and subjective assist-
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ommend it for use as a muscle relaxant and anal-
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XXVIII

NORTH CAROLINA MEDICAL JOURNAL

December, 1960

an antibiotic improvement
designed to provide

greater therapeutic effectiveness

<<

\

\

now
Ilosone

( propionyl erythromycin ester lauryl sulfate, Lilly)

in a more acid-stable form

assure adequate absorption even when taken with food

Ilosone retains 97.3 percent of its antibacterial activity after exposure to gastric
juice (pH 1.1) for forty minutes.1 This means there is more antibiotic available
for absorption— greater therapeutic activity. Clinically, too, Ilosone has been
shown- 3 to be decisively effective in a wide variety of bacterial infections — with
a reassuring record of safety.4

Usual dosage for adults and for children over fifty pounds is 250 mg. every six hours.
Supplied in 125 and 250-mg. Pulvules and in suspension and drops.

1. Stephens. V. C, et al.: J. Am. Pharm. A. (Scient. Ed.). 48/620, 1959.

2. Salitsky, S., et al.: Antibiotics Annual, p. 893, 1959-1960.

3. Reichelderfer, T. E.. et al.: Antibiotics Annual, p. 899, 1959-1960.

4. Kuder. H. V,: Clin. Pharmacol. & Therap., in press.

ELI LILLY AND COMPANY

INDIANAPOLIS 6, INDIANA, U.S.A.

North Carolina Medical Journal

Owned and Published by
The Medical Society of the State of North Carolina

Volume 21

December, 1960

No. 12

Esophageal Emergencies

Frederick H. Taylor, M.D.

Paul W. Sanger, M.D.

Francis Robicsek, M.D.

and

Terry Rees, M.D.

Charlotte

Most non-malignant esophageal emergen-
cies lend themselves readily to satisfactory
treatment if the diagnosis is promptly and
correctly made. These conditions include
obstructions, foreign bodies, injuries, and
hemorrhage.

Obstructions

The great majority of acquired esopha-
geal obstructions are of a chronic nature.
The congenital esophageal obstructions, how-
ever, present an urgent and challenging
situation. Congenital esophageal atresia,
with or without tracheoesophageal fistula, if
undetected invariably leads to a fatal out-
come.

The diagnosis of esophageal atresia should
be suspected during the first hours of life in
any infant who cannot handle his saliva.
There may also be strangling and cyanosis.
Abdominal distention is common when a
tracheoesophageal fistula is present. Normal-
ly, of course, the abdomen is flat. When an
infant strangles and is unable to swallow
his first feeding, esophageal atresia must be
suspected immediately and the diagnosis
established by roentgen examination. The
passage of a small catheter through the
nose into the esophagus is a helpful diagnos-
: tic test. The catheter, however, can be mis-
leading at times by curling up in an esopha-
geal blind pouch, making the examiner think
he has passed enough of the tube to reach
i the stomach. The instillation of Lipiodol
into the esophagus is mandatory. The blind
pouch of esophagus usually ends at about
jthe fourth thoracic vertebra (fig. 1).

The presence of air in the gastrointestinal
I tract confirms the presence of a tracheo-
iesophageal fistula (fig. 2). The absence of

air in the tract is suggestive, but not abso-
lutely diagnostic, of the absence of associ-
ated tracheoesophageal fistula (fig. 1). In-
fants with congenital esophageal atresia
usually have an associated tracheoesophageal
fistula. The various anatomic combinations
can be found in most any pediatric or sur-
gical text.

Infants with esophageal atresia become
dehydrated and septic from rapidly develop-
ing pneumonia (fig. 2). Aspiration of saliva
and milk and regurgitation of irritating
gastric juice across a tracheoesophageal
fistula lead to severe pulmonary sepsis. Im-
mediate operation is not necessarily indi-
cated. These infants are usually premature
and underweight, and several hours of pre-
operative management often make them
better operative risks. Preoperative therapy
consists of fluids given through a venous
cutdown to improve hydration, penicillin
and streptomycin, and frequent suction of
the pharynx. Elevating the infant's head
seems to. decrease the amount of gastric
juice which crosses a tracheoesophageal
fistula. This initial medical care followed by
proper corrective surgery (fig. 3) may lead
to a salvage rate of 50-75 per cent.

Foreign Bodies

Foreign bodies of the esophagus are of
major importance, and should always be re-
moved promptly.. Severe complications of
stricture, perforation, or hemorrhage may
result from leaving a foreign body in the
esophagus. X-ray examination should pre-
cede endoscopy. Radio-opaque foreign
bodies in the esophagus are easily detected
by plain postero-anterior and lateral roent-
genograms of cervical and thoracic areas

530

NORTH CAROLINA MEDICAL JOURNAL

December, I960

(fig. 4). Non-opaque foreign bodies must be
visualized with contrast media (fig. 5).
Failure to examine the esophagus radio-
graphically can lead to costly oversights
(figs. 6 and 7). When x-ray examination
demonstrates a foreign body, immediate re-
moval by an endoscopist is indicated. Even
in the absence of roentgenographs evidence,
endoscopy may still be indicated if the pa-
tient's complaints suggest the presence of a
foreign body. Recurrent meat impactions at
the cardia can usually be dissolved by a tea-
spoonful of essence of caroid.

Trauma

Perforations

Perforations of the esophagus are true
emergencies, and when undetected usually
lead to a fatal mediastinitis.

Spontaneous perforation of the esophagus
almost always occurs during a bout of vom-
iting and retching — often after a drinking
spree. The onset is sudden and is character-
ized by intense tearing pain in the substern-
al or epigastric areas, frequently radiating
to the back or shoulders. Shock usually fol-
lows the onset of pain. Spontaneous perfor-
ation of the esophagus is often confused
with acute coronary occlusion or ruptured
peptic ulcer. This is a fatal mistake (figs.
9, 10, 11). A roentgenogram of the chest
(fig. 8) will usually show mediastinal em-
physema and pleural reaction (usually on
the left side) . Pneumothorax may occur. A
Lipiodol swallow is extremely helpful in es-
tablishing the diagnosis. When the diagnosis
is made promptly, immediate repair
done. The tear is almost invariablv on the

Fig. 1. (Left) Esophageal atresia without tracheo-esophageal fistula. Lipiodol instillation shows typical
proximal blind pouch of esophagus. Absence of air in gastrointestinal tract confirms lack of tracheo-esopha-
geal communication.

Fig. 2. (Right) Esophageal atresia with tracheo-esophageal fistula. Roentgenogram of the chest shows
right upper pneumonia. Air in gastrointestinal tract proves the presence of a tracheo-esophageal fistula. >ra

December, 1960

ESOPHAGEAL EMERGENCIES— TAYLOR AND OTHERS

531

Fig. 3. Postoperative Lipiodol swallow of case in
fig. 2. The tracheoesophageal fistula has been re-
paired and the esophagus repaired in continuity,
permitting normal swallowing.

left lateral wall of the esophagus just above
the cardia. Sepsis occurs early and is man-
aged by drainage, usually drainage of the
left pleural space. Intensive antibiotics and
parenteral alimentation are of course con-
tinued through the acute stage. Feeding gas-
trostomy or jejunostomy may be required
in slow-healing perforations.

Perforations by foreign bodies are occa-
sionally seen. Sharp objects such as bones
or pins are notorious offenders. The history
and x-ray findings (fig. 12) will point to
this diagnosis. Not only is immediate eso-
, phageal repair or drainage or both indicated,
I but also the offending foreign body must be
• removed.

Instrumental perforation of the esophagus
is an infrequent but important complication
which may occur during esophagoscopy,
gastroscopy, or esophageal dilatation. It
may even result from an anesthetist's clum-
sy attempt to pass an endotracheal tube. Al-
though the complication is uncommon, it
should be recognized when it occurs. The en-
doscopist may actually see the laceration
during his examination or suspect it from
the patient's discomfort. Confirmatory evi-
dence is noted by the palpation of subcu-
taneous emphysema in the neck, and x-ray
evidence of mediastinal or pleural air and
extravasation of Lipiodol (fig. 13). When
recognized immediately, instrumental lacer-
ations should be repaired. After several
hours an intense inflammatory reaction oc-
curs, and drainage rather than repair is in-
dicated. The usual sites of perforation are
the pharyngo-esophageal junction and the
lower esophagus at the cardia.

Perforations of surgical wounds are not
rare and can be successfully salvaged. Leak-
age at the site of an esophagogastric anas-
tomosis is a constant threat, particularly in
patients emaciated from cancer. These su-
ture breakdowns as a rule occur from the
fourth to tenth postoperative day, and are
suspected when sepsis or back pain become
evident. Lipiodol swallow (fig. 14) will con-
firm the clinical diagnosis. No attempt is
made to repair these surgical leaks because
of the intense inflammatory reaction. Drain-

Fig. 4. Foreign body (a penny) removed by eso-
phagoscopy. Metallic foreign bodies are easily
demonstrated by plain roentgenograms without the
use of contrast media.

532

NORTH CAROLINA MEDICAL JOURNAL

December, 1960

Fig. 5. (Left) Large bolus of meat impacted in lower esophagus demonstrated by barium swallow.

Fig. 6. (Right Foreign body (penny) of esophag
months by gastrostomy and retrograde dilatations for
never been taken. Plain chest roentgenogram shows a
esophagoscopy. A roentgenogram at the onset would
eign body.

age by posterior mediastinotomy or a trans-
pleural approach is done as indicated. A
feeding jejunostomy should also be done.
(Gastrostomy usually leads to leakage of
feeding fluid through the perforation.)

Perforation due to cancer of the esopha-
gus is an extremely lethal complication. If
the perforation is sudden, a decision must
be reached as to whether immediate resec-
tion is indicated, as later resection will
probably not be possible. Drainage by pos-
terior mediastinotomy may lessen the dis-
comfort of sepsis, but a cancerous perfora-
tion should not be expected to heal.

us. This 4 year-old girl had been treated for several
so-called esophageal stricture. A roentgenogram had

metallic foreign body (penny) which was removed by
have resulted in prompt and easy removal of the for-

Perforations from penetrating objects
such as bullets and knives are often over-
looked. A swallow of Lipiodol should be
given when any penetrating object traverses
the area of the esophagus. The diagnosis can
be made only when the possibility is con-
sidered. Mediastinal exploration for repair
of a gunshot wound of the esophagus is a
must'1*. Adequate drainage, combined with
feeding gastrostomy or jejunostomy, will
usually lead to excellent healing of the in-
jured esophagus.

Chemical burns

Soda lye is the common offending agent
in this distressing type of esophageal trau-

December, 1960

ESOPHAGEAL EMERGENCIES— TAYLOR AND OTHERS

533

Fig. 7. Foreign body of esophagus with unneces-
sary delay in diagnosis. This child had dysphagia
for two years before a roentgenogram was taken.
The penny is easily demonstrated and Lipiodol
shows beginning of stricture formation.

ma. So often the victims are small children
who accidently ingest the caustic material
thinking it is milk. Ingestion of lye by an
adult is usually done with suicidal intent.

It is virtually impossible to neutralize in-
gested lye promptly enough to be effective.
Mild acids such as vinegar are worth a try
as immediate first aid, but results are doubt-
ful. A patient with an acute lye burn is
given nothing by mouth, except possibly a
few sips of olive oil for its soothing effect.
Since esophageal lye burns are complicated
by secondary intramural bacterial ab-
scesses1-', intensive antibiotic therapy is
mandatory. Penicillin and streptomycin in
large amounts are effective antibiotics. Since
corticosteroids tend to decrease inflamma-
tory reactions, we recommend their use.
Perforation of the esophagus can occur and
demands immediate drainage.

The inflamed area in the mouth and
pharynx is examined daily. When the acute
reaction in the throat subsides, a Lipiodol
swallow is given, followed by x-raj- examin-
ation. If the tissue reaction has apparently
subsided, a careful esophagoscopic examin-
ation is carried out. Some of these patients

Fig. 8. (Left) Spontaneous rupture of esophagus. Early roentgenogram appearance including mediastin-
al emphysema and pleural effusion.

Fig. 9. (Right) Spontaneous rupture of esophagus. The diagnosis wrs overlooked and patient was oper-
ated upon for ruptured duodenal ulcer. The delay in diagnosis led to a fatal outcome despite drainage of
the empyema.

534

NORTH CAROLINA MEDICAL JOURNAL

December, 1960

Fig. 10. (Left) Spontaneous rupture of the esophagus. The patient had sudden epigastric pain during a
bout of vomiting. An incorrect diagnosis of ruptured duodena] ulcer was followed by an abdominal explora-
tion with negative findings. The correct diagnosis was established on the twelfth postoperative day by x-ray
examination. Mediastinal abscess with air-fluid level is seen on plain roentgenogram.

Fig. 11. (Right) Roentgenogram following Lipiodol swallow in same patient as seen in figure 10. Ex-
travasation of Lipiodol into mediastinum is evident.

prove to have no esophageal burn, indicat-
ing that they expectorated the lye rather
than actually swallowing it. The advocates
of early dilatation always get an excellent
result in such cases !

A true lye burn of the esophagus is al-
most always followed by some degree of
stricture (fig. 15). Mild, localized stricture
may be helped by a few judicial dilatations.
Severe, long strictures should be corrected
surgically by transplantation of the stomach
or right portion of the colon (fig. 16). These
major plastic procedures are naturally clone
after the acute inflammatory reaction has
subsided. Feeding gastrostomy or jejunos-
tomy are valuable and necessary adjuncts
to the long-term management of lye burns.
It should be remembered that even the acid-
bearing stomach can be virtually destroyed
by the corrosive action of lye. This possibil-
ity must be remembered before beginning
any major reconstructive procedure (fig.
17).

Hemorrhage
Esophageal varices

Varices are most often the cause of ex-
sanguinating esophageal bleeding. The diag-
nosis of these lesions can be difficult. The
previous history and gastrointestinal roent-
genograms are helpful. The lesions are best
demonstrated by barium swallow with x-ray
examination (fig. 18). Esophagoscopy in the
presence of varices can be hazardous and
may not demonstrate the source of bleeding.
Womack'4' has suggested that bleeding from
esophageal varices appears to have some
arterial component, as evidenced by high
oxygen saturation of blood collected from
them. We have been impressed by the ar-
terial nature of the bright red blood spurt-
ing from varices noted at operation. If these
varices were produced by simple back
pressure from intrahepatic venous obstruc-
tion, one would expect the spurting blood to
be markedly desaturated. (Operative inci-
sions over the neck or chest in the presence

December, 1960

ESOPHAGEAL EMERGENCIES— TAYLOR AND OTHERS

535

Fig. 12. (Left) Perforation of the esophagus by foreign body. Lipiodol swallow demonstrates extrava-
sation through a perforation created by a chicken bone.

Fig. 13. (Right) Instrumental perforation of esophagus. Pain following esophagoscopy led to Lipiodol
swallow, which demonstrated extravasation into the mediastinum.

of superior vena caval obstruction yield
blood which is virtually black.)

We consider bleeding from esophageal
varices similar to bleeding from a knife
wound — that is, if it persists, operation
should be undertaken before pouring 15 to
20 pints of blood into the patient. Trans-
thoracic ligation of esophageal and gastric
varices and splenectomy have proved to give
very satisfactory results in our hands.

Endoesophageal balloons are often disap-
pointing. They do not control gastric
bleeders and are not without danger of
causing esophageal perforation. Portacaval
shunt for the treatment of acute active
bleeding has not been used by us as an emer-
gency procedure.
Esophagitis

Bleeding associated with esophagitis is
usually not as severe as with varices. Eso-
phagitis may result from hiatus hernia (par-
ticularly the "short esophagus" type) or
achylasia, or it may follow plastic or resec-
tive surgery of the esophagogastric junction.
Bleeding from esophagitis due to hiatal

hernia will usually subside following cor-
rection of an easily reducible hernia. The
short-esophagus type of hernia may require
pyloroplasty, as advocated by Burford and
Lischer141 to control the esophagitis. Severe
bleeding from esophagitis following esopha-
gogastric surgery may require further re-
section and pyloroplasty.
Aortic aneurysms

Esophageal bleeding may come from
aortic aneurysms. Arteriosclerotic, luetic, or
traumatic aneurysms may erode the esopha-
gus and cause hemorrhage. This bleeding is
not always immediately fatal, and may be
controlled by resection and graft of the
aneurysm in selected cases. We recently saw
a 7 year old patient with coarctation of the
aorta who had had intermittent esophageal
bleeding of two weeks' duration. Operation
showed a post-coarctation aneurysm which
had perforated into the esophagus. An adult
patient who had previously had a local
sleeve resection of a lower esophageal
stricture acquired a recurrent esophageal
ulcer which perforated posteriorly directly

536

NORTH CAROLINA MEDICAL JOURNAL

December, 1960

Fig. 14. (Left) Leakage al esophagogastric anastomosis following resection for cancer of esophagus.
Fig. 15. (Right) Complete stricture of esonhagus resuling from lye burn.

Fig. 16. (Left) Colon substitution for esophagus which had been destroyed by lye burn. The right colon
lies in^he anterior mediastinum and connects -with the cervical esophagus above and the pylorus below. This
colon substitute functions well two years postoperatively.

Fig. 17. (Right) Lye burn of stomach. The persistent napkin-ring deformity of the stomach necessi-
tated use of colon as an esophageal substitute.

December, 1960

ESOPHAGEAL EMERGENCIES— TAYLOR AND OTHERS

537

Fig. 18. Esophageal varices. Barium swallow
shows typical long rilling deformities created by
varices.

into the aorta, leading to severe hemorrhage.
The ulcer and aortic fistula were closed in
situ, and emergency esophagogastrostomy
was done.

Mucosal lacerations

Esophageal bleeding from mucosal lacer-
ations is apparently rare. We had one pa-
tient who developed severe esophageal bleed-
ing after swallowing a pork chop bone.
Esophagoscopy demonstrated a mucosal lac-
eration of the posterior wall of the lower
esophagus. The bleeding was stopped by
the application of an epinephrine-soaked
sponge. Prompt healing occurred without
further complication.

Summari/
A number of esophageal lesions of an ur-
gent nature are discussed. These lesions are
usually readily diagnosed by history, physi-
cal examination, and in particular by x-ray
findings. The use of plain roentgenograms
with Lipiodol or barium swallow, supple-
mented when indicated by esophagoscopy,
will almost invariably lead to correct diag-
nosis. Prompt recognition and correct treat-
ment of these lesions lead to gratifying re-
sults.

References

1. Sanger. P.: Thoracic Trauma, Surg. Clin. Norh America,
36:1277-1287 (Oct.) 1956.

2. Bosher, L., Burford, T., and Ackerman, L.: The Pathol-
ogy of Experimentally Produced Lye Burns and Strictures
of the Esophagus, J. Thorac. Surg. 21:483-489 (May) 1951.

3. Womack. N.: Discussion of Bleeding Esophageal Varices,
North Carolina Chapter, American College of Surgeons,
Chapel Hill, 1959.

1. Burford, T. H., and Lischer, C E.: Treatment of Short
Esophageal Hernia with Esophagitis by Finney Pyloro-
plasty, Ann. Surg. 144:647-652 (Oct.) 1956.

Every year I am told that Americans buy over the drug counters
about $250,000,000 worth of vitamins. It is safe to say that at least
$240,000,000 of this is wasted. No reason whatever exists for the taking
of vitamins by any healthy adult American on an adequate diet. There
is good reason often for correcting the diet of people who have faulty
eating habits. The giving of vitamins in no sense is a substitute for a
faulty diet in an otherwise normal person. Vitamin B12 is of no value
whatever except in one group of rare diseases, the macrocytic anemias.
— Forkner, C. E.: Drug Mixtures, New England J. Med. 259:439 (Aug.
28) 1958.

5.38

December, 1960

Outbreak of Waterborne Disease in a City School

Arthur S. Chesson, Jr., M.D.*
Goldsboro

The purpose of this review is to present
the details of an outbreak of sewage poison-
ing among students at William Street Ele-
mentary School in Goldsboro. An effort will
be made to point out the importance of com-
munity cooperation in such a crisis. The
epidemiogic investigation is reported in a
paper by Dr. Jacob Koomen, assistant di-
rector of the Division of Epidemiology of
the North Carolina State Department of
Carolina State Department of Health.

Report of Outbreak and Early Investigation
At 2:30 p.m. on Thursday, September 10,
1959, a local general practitioner called me
at the Wayne County Health Department,
stating that he had seen six children from
William Street School that day, all of whom
presented gastrointestinal symptoms that
appeared to warrant investigation by the
Health Department. We then called the
principal of William Street School, who gave
the following story:

At approximately 10:00 o'clock that
morning students began manifesting symp-
toms of acute nausea and vomiting severe
enough to require immediate attention. All
these children were sent or taken home as
they became sick. The principal had noticed
that the illness apparently began in the
older age group in the morning, spreading
to the younger children in the afternoon.

Food and milk supply

A sanitarian from the Health Depart-
ment was sent to the school to inspect the
lunchroom and interview employees con-
cerning the menus, food-handling practices,
refrigeration, and dishwashing facilities of
the past few days. He reported that the
lunchroom and kitchen were in an excellent
state of cleanliness, that all equipment was
and had been operating properly, and that
there was no history or evidence of illness
in any of the food-handlers which might be
considered as a source of the outbreak. Since
there was no leftover food for bacteriologic
analysis, unopened cans of food from the
same lot used in preparing the previous
day's luncheon were examined. Next, a
thorough investigation of the milk supply,

"Health Director, Wayne County Health Department, Golds-
boro, North Carolina.

with the cooperation of the distributors and
other schools obtaining milk from the same
source, disclosed no contamination here.
Other factors

At this point it appeared that the usual
case of food poisoning could not be proved
in this instance, and that a much more thor-
ough investigation would be required to
reveal the source of the outbreak. The sani-
tarian's next task therefore, was to investi-
gate environ-factors other than the lunch-
room which might be responsible. Among
those considered were toxic reactions to in-
secticides and chemical sprays used for
cleaning floors, windows, and bathrooms.
On his second visit to the school the sani-
tarian learned that on the preceding Tues-
day the janitor had had to remove roots
from a sewer line which had been causing
a backfiow in the toilets of South building.

It should be pointed out here that approx-
imately 1,000 students attend William Street
School. These pupils are located in three
buildings, referred to henceforth as North,
Central, and South. The lunchroom is lo-
cated in a separate building, and another
frame building is used for a class of re-
tarded children. Since there was no evidence
that any toxic agent had been used in any
of these buildings, the only positive finding
early Thursday evening was the temporary
stoppage of one sewer. This fact suggested
the classical story of cross connections in
the plumbing of Chicago hotels, which re-
sulted in an outbreak of amebiasis.

Community Cooperation
Early that evening, contact with other
private practitioners in the community re-
vealed that the outbreak was characterized
by fevers of 103 to 104 degrees, abdominal
cramps, nausea, vomiting, and diarrhea. Be-
cause the etiology was unknown, the cases
were being treated symptomatically.

It was apparent from these reports that
the outbreak would involve the majority of
the students and some of the teachers of
William Street School, and was not limited
to any particular group. Because the cause
had not been determined, the superintendent
of city schools was advised to keep the Wil-
liam Street School closed the following clay,
Friday, September 11. This recommendation

December, 1960

WATERBORNE DISEASE— CHESSON

539

was followed and the announcement was
made over local radio stations. Although
there was general concern about the out-
break, the community remained calm as the
result of frequent news releases, conversa-
tions, and close cooperation with such com-
munity leaders as the Mayor, City Manager,
principals of uninvolved schools, and pri-
vate physicians.

Iuvestigation of Water Supply ..

Since the possibility of some cross con-
nection or contamination in the city water
supply had been suggested, the City Man-
ager arranged to have water samples taken
from the William Street School buildings
Thursday night for analysis. On Friday the
lunchroom was again inspected and the pro-
cedures for the week were reviewed. For a
second time the findings were completely
negative. Tests for residual chlorine using a
Hellig Pocket Comparator, which has a
range of 0.2 to 3.0 parts per million, were
made at William Street School. No residual
chlorine was found in the water supply
there, nor at the Health Department, located
approximately % mile distant, nor at a resi-
dence about 1 mile distant. Immediate in-
crease in chlorination at the City Water
Plant resulted in residual chlorine at Wil-
liam Street School the following day.

At this time a vegetable dye was used in
an effort to discover any direct cross con-
nection which might be present in the
plumbing of these buildings. We later found
that this was an ineffectual method of dis-
covering such a cross connection even if one
had been present. An inspection was then
made of the sewage system which had been
stopped up earlier in the week. It was re-
vealed that the sewage line lay immediately
above the incoming water line for South
building, and that this line had been opened
at exactly the same point on the preceding
Tuesday and on many previous occasions.
There was, however, no indication of over-
flow at this site, even though a water-tight
repair had not been accomplished.

By late evening Saturday, September 12,
many! of the water samples taken from
these school buildings were showing pre-
sumptive positive results; however, since
the water plant operator had recently
adopted a new technique, he had some reser-
vations as to the significance of these tests.
Water samples from the three school build-
ings and lunchroom had also been sent the

North Carolina State Laboratory of Hygiene
for analysis. However, reports of these
analyses were not then available.

At this point, though it appeared that we
had found the source of contamination
which was responsible for the present out-
break, we were not able to explain why or
how the contamination of water was occur-
ring, nor how it could affect the children in
all three buildings. It was encouraging,
however, that samples taken from the lunch-
room were reported presumptive negative.
During these days attending physicians were
asked to have the patient's families submit
stool specimens to the State Laboratory of
Hygiene in order to isolate an organism, if
possible. Dr. Koomen's epidemiologic report
will show that this is a difficult task to have
performed by families of patients.

Review of Food Sources
Still not satisfied that we had investigated
every avenue of a foodborne infection, we
interviewed each lunchroom employee at her
home. These interviews disclosed that it was
a standing practice in the lunchroom for em-
ployees to take home leftover food. Fear of
disciplinary action prevented them from
volunteering this information readily, but
on being reassured each employee cooperated
fully by reporting the exact foods which had
been taken home during the five days prior
to and including the day of the outbreak. No
illness resembling the symptomatology pre-
sented by the students was reported in any
of the employees or their families.

The next step was a door-to-door canvass
of the homes located across the street from
the school. This investigation revealed no
illness similar to that experienced by the
children, further strengthening the proba-
bility that the contamination was occurring
within the school buildings proper rather
than in the city water mains.;;; ;~

Assistance of National Guard
The Commander of the local National
Guard unit was requested to provide the
school with a temporary water supply for
handwashing and drinking. The unit co-
operated completely, and the temporary sup-
ply was begun on Monday, September 14,
and continued until the epidemiologic in-
vestigation was completed and repairs to
the school plumbing system were made. All
water was cut off in North, Central, and
South buildings except that necessary for
operation of urinals and water closets. Since

540

NORTH CAROLINA MEDICAL JOURNAL

December, 1960

the water samples from the lunchroom con-
tinued to show negative results, this system
was left functioning.

Cooperation of State Health Department
At the request of the local Health Depart-
ment, the State Board of Health assigned
the following personnel to continue the in-
vestigation : Dr. Jacob Koomen, assistant
Director of the Division of Epidemiology;
Miss Elizabeth A. Zacha, nurse epidemiolo-
gist of the United States Public Health
Service, assigned to the State Board of
Health ; and Mr. W. J. Stevenson, district
sanitary engineer of the State Board of
Health. Their investigation was most de-
tailed and, like the earlier effort, met with
the full cooperation of the city school super-
intendent, the principal and teachers of Wil-
liam Street School, the City Manager, and
the superintendent of the city water system.
On Monday, September 14, it was as-
sumed on the basis of available information

that contaminated water was the cause of
the epidemic. It was obvious, however, that
a statistical analysis as well as an engineer-
ing survey was necessary in order to estab-
lish the source of the contamination. This
phase of the epidemiologic investigation will
be discussed by Dr. Koomen.

Summary
The preliminary investigation of an out-
break of waterborne disease in a city school
has been reviewed. Emphasis has been
placed on the necessity of cooperation be-
tween the various community agencies in the
solution of such a problem. The preliminary
investigation, while eliminating many possi-
ble sources of the outbreak, nevertheless did
not substantiate the exact cause. Probably
no community in our state is capable of
completing such an epidemiologic study
without the assistance of the State Board of
Health. The results of their efforts will be
apparent in Dr. Koomen's report.

An Outbreak of Unusual Waterborne Illness
in Wayne County — Epidemiologic Aspects

Jacob Koomen, Jr., M.D., M.P.H.*

Elizabeth A. Zacha, R. N., B.S.**

Wm. J. Stevenson, M.S.t

Raleigh

and

Arthur S. Chesson, Jr., M.D., M.P.H.J

Goldsboro

This report describes some epidemiologic
aspects of an outbreak of acute gastroen-
teritis occurring among pupils and teachers
of the William Street Elementary School,
Goldsboro, shortly after the opening of the
fall term in 1959. Goldsboro schools opened
on Wednesday, September 2, 1959; eight
days later, on September 10, an illness of 48
hours' duration, characterized by high fever
(103-104 F.), abdominal cramps, nausea,

•Assistant Director, Division of Epidemiology, North Car-
olina State Board of Health, Raleigh.

**Nurse epidemiologist assigned to the Division of Epidem-
iology by the Communicable Disease Center. Public Health
Service. U. S. Dept. of Health. Education, and Welfare. At-
lanta, Georgia.

fDistrict Sanitary Engineer. North Carolina State Board of
Health.

^Health Director, Wayne County Health Department, Golds-
boro, North Carolina.

vomiting and diarrhea was seen in a large
number of teachers and students.

Preliminary investigation, as noted by
Dr. Arthur S. Chesson, Jr., Health Director,
Wayne County Health Department, pointed
strongly to a common source of illness. Food
was exonerated in the preliminary study
and the water supply implicated as the
probable common source of illness.

At the request of the local Health Direc-
tor, personnel of the Division of Epidemiol-
ogy, North Carolina State Boai-d of Health,
visited the Health Department and school
on September 14, 1959, to aid in further in-
vestigation. At that time it was estimated
that 20 to 30 per cent of the total school
population of 1089 pupils had been ill.

December, 1960

WATERBORNE DISEASE— KOOMEN AND OTHERS

541

G0LDSB0RO SCHOOL--STIOWITO WATER & SE jES LIHES

i^ms sr/tEpi

SooTK

HCKTH

V

— S£WER

— iYATER !

GW

*

*

r

pi 3

:■

r

i'

Figure 1

Materials and Methods

Six buildings are located on the school
grounds as shown in figure I. Three are
large classroom buildings constructed ap-
proximately 40 years ago. These buildings
are called North, Central and South; North
contains three classroom floors ; Central and
South buildings contain two classroom floors
each. A gymnasium, unused at this time, is
housed in a separate building. The cafeteria,
a newly constructed one-story building, is
also an independent structure. A sixth struc-
ture, formerly a two-story frame house, is
used as a classroom building for a small
group of exceptional children.

Major classroom buildings, North, Cen-
tral and South, face William Street, while
the cafeteria and frame building face Vine
Street, the latter street forming the north
border of the school grounds. The school
grounds do not fill the entire city block.
Homes and commercial establishments make
up the south portion of the block and parts
of the north and east borders as well.

Water samples for bacteriologic analysis
were obtained from several sources within
and outside the buildings. Outside sites con-
sisted of the various fountains noted in fig-
ure I.

The student body consists of 1,089 white
pupils distributed in grades 1 through 6.
The professional staff is made up of 35
teachers and a principal ; all are women.
Nine persons are associated with the cafe-
teria. A custodian completes the personnel.

Questionnaires were distributed to each
teacher requesting information relative to
her own sources of drinking water, the
fountains customarily used by her pupils,
and the names of all students and date of
onset for each child experiencing illness.

Table 1
Bacteriologic Analysis of Water Samples
Date Location Result

Presump- Con-
tive* firmed

9/10 South, upstairs, fountain 3/5

South, outside, fountain 5/5

Central, inside, fountain 2/5 Not done

North, inside, fountain 2/5

Cafeteria, inside, tap 0/5

9/11 South, outside, fountain 5/5 Positive

Central, outside, fountain 2/5 Negative

North, outside, fountain 2/5 Negative

Cafeteria, outside, fountain 0/5
Cafeteria, inside, tap 0/5

It was felt that the children were unlikely
to be able to report reliably use of the drink-
ing fountains from the opening of school. As
noted above, an effort was made to obtain
such data from the teaching staff in the hope
that this group might be able to recall such
information with some degree of correct-
ness.

A number of patients were requested
through their physicians to submit stool
specimens for bacteriologic examination.

Results and Discussion

Water samples obtained on September 10,
1959 showed, as indicated in table 1, possi-
ble evidence of contamination in four of five
sites selected for sampling. A sample ob-
tained from a cafeteria building tap was
negative. Each of the major classroom
buildings was represented in samples taken
from a fountain associated with each struc-
ture. Each as mentioned above showed evi-
dence of possible contamination. Satisfac-
tory confirmatory tests were not carried out,
however. On the day following the outbreak,
September 11, samples from five drinking
fountains were obtained for study. Each
classroom building and an outside cafeteria
fountain tap were represented. On this date,
only the specimen from the outside drinking
fountain, South Building, was positive in
the confirmed test. Valid comparisons can-
not be made between results of bacteriologic
examinations made on the two days, since
confirmatory tests were not carried out on
the initial specimens. Presumptive tests
point to the presence of contamination of
drinking water in the three major classroom
buildings on September 10. Whether the
negative findings of the second day of samp-
ling reflect the increased residual chlorine
level or flushing of the water system or a
combination of both is a matter for specula-
tion. The findings are presented in table 1.

542

NORTH CAROLINA MEDICAL JOURNAL

December, 1960

Table 2

Distribution of Cases Among;

Students and Teachers by Date

Percent, of
Date No. Cases Total 111

9/8 4 0.8

9/9 33 7.1

9/10 328 70.4

9/11 86 18.5

9/12 5 1.1

9/13 6 1.3

9/14 4 0.8

Evaluation of locally available data and
excavation revealed that the three major
classroom buildings received water inde-
pendently from a main on the near side of
William Street. The cafeteria and frame
building receive water from a main on Vine
Street. The sewer line from North Building
flows to a William Street main ; sewer lines
from the cafeteria and the frame building
flow to a Vine Street main. Sewer lines from
South and Central Buildings combine to flow
in an easterly direction. As noted in Dr.
Chesson's paper, it appeared that placement
of sewer lines was an important factor in
the conditions leading to the outbreak of ill-
ness. Subsequent events showed this premise
to be untrue.

No cross connection between water and
sewer were associated with any single build-
ing or among the buildings. Furthermore,
cross connections in water lines between
buildings were not demonstrated. Dye stud-
ies, to be discussed later, were used in an
attempt to establish patterns of water flow
within individual buildings.

From interviews with the school's staff, it
was learned that outside play is organized
for pupils at all grade levels ; each class-
room group is assigned a specific play area.
In general, each individual classroom group
uses the same water fountain. Patterns of
fountain use, while fairly regular, however,
are not absolutely rigid. Pupils of the ex-
ceptional class group may use various play-
ground fountains during outside play.

Table 2 shows that 466 individuals, stu-
dents, and teachers became ill with symp-
toms felt to be characteristic of the present
outbreak. Ninety-six per cent of the cases

Table 4
Distribution of Cases Among Pupils by Grade Level

Grade

Total No.

No. Ill

Percent. Ill

1

83

0

0

2

SI

25

29.8

3

89

11

46.1

4

98

48

49.0

5

374

171

45.8

6

350

161

46.0

Special class

11

5

45.4

Total

1,089

451

41.4

occurred in the period September 9-11, with
70.4 per cent occurring on September 10.
These data indicate the outbreak to be one
of the common-source type.

In table 3, attack rates by building are
computed. The attack rates in the North and
South Buildings are approximately equal
(44-50 per cent). A considerably lower at-
tack rate (under 30 per cent) was found in
the Central Building. This difference will be
explained. Evidence obtained from question-
naires indicated that fountains associated
with each large classroom building were im-
plicated as sources of contaminated water.

Attack rates by grade, as seen in table 4,
disclosed illness occurring in 45-50 per cent
of those in grade 3 and above. The attack
rate in grade 1 was zero and in grade 2 was
29.8 per cent. Since all first and second
grade pupils are housed in the Central
Building, the low attack rate associated with
this building is explained. First grade
teachers reported that their pupils had not
yet learned to manipulate the drinking foun-
tain levers. Also, a number of second grade
students were not yet large enough to reach
the fountains easily and did not drink water
in school. Twenty-two upper grade students
absent on September 7 or 8 did not become
ill.

Differences in sex distribution of cases
was not seen in the major classroom build-
ings, the attack rate among males and fe-
males being approximately equal. In the ex-
ceptional group of children, 2 of 7 boys, and
3 of 4 girls became ill. Differences in sex
distribution are not explained. The number
of children involved, however, is small.

Table 3

Attack Rate, by

Build

ing, Among Pupils

and Tea

chers

Building

Pupils

Teachers

Total

Total No.

No. Ill % 111

Total 111 No. Ill

%I11

Total No.

No. Ill

%m

North

597

263 44.1

19 8

42.1

616

271

44.0

Central

227

53 23.3

8 4

50.0

235

57

24.3

South

254

130 51.2

8 2

25.0

262

132

50.4

Special class

11

5 45.5

1 1

100.0

12

6

50.0

Totals

1089

451 41.4

36 1 5

41.7

1125

466

41.4

December, 1960

WATERBORNE DISEASE— KOOMEN AND OTHERS

543

Table 5
Relationship of Attack Rate to Water Consumption
Consumed Water Did Not Consume Water

No. No. Ill ^c 111 No. No. Ill %I11

22 13 59.1 14 2 14.3

As noted in table 3, 15 teachers became
ill, showing an attack rate of 41.7 per cent
among- the professional staff of 36 (35
teachers and principal). Further question-
ing revealed that 22 teachers had consumed
drinking water at school at sometime dur-
ing the week of the outbreak. Of this num-
ber, 13 or 51.9 per cent became ill. Fourteen
disclaimed drinking water at school during
the week of illness. Two of this number, or
14.3 per cent, became ill. Their illness is un-
explained. Table 5 presents these data.

Review of the use of drinking fountains
by teachers, as presented in table 6, shows
that no building — major classroom and caf-
eteria— can be exonerated as a possible
source of the causative agent. Central Build-
ing drinking water supply was not put to
test, since no teacher consumed drinking
water from a source connected with this
building alone. No cafeteria staff member
exhibited illness, nor did the custodian.

In an effort to trace the movement of
water in each of the classroom buildings,
sodium fluorescein was introduced into lav-
atory taps in the second floor rest rooms of
the South and Central Buildings, respective-
ly. Dye ultimately appeared in the South
Building's outside water fountain and in all
inside ground floor fixtures of the Central
Building. Unfortunately, dye indicator tests
were not carried out in the North Building.
It was observed, however, that flushing the
ground-floor toilet fixtures caused water to
disappear completely from fountains on the
upper floors, indicating possible backflow
when water pressure was reduced by usage.
Of interest is the fact that the school cus-
todian reported complete stoppage and over-
flow of second-floor commodes in South
Building on September 8. Survey of the
plumbing system revealed that in the past
tank - type commode flushing mechanisms
had been replaced with the more modern
demand-type. In making the change, water
lines had not been protected by installation
of backflow preventers or vacuum breakers.

Water lines serving each classroom build-
ing were exposed. As indicated above, no
cross connections were found. A 2-inch
water line to North Building was found to
be inadequate for proper service. A 4-inch

Table 6

Relationship of Water Fountain Use to

Illness Among Teachers

Fountain Used

Total

Number 111

Not

North Only

5

4

1

South Only

2

1

1

Central Only

0

0

0

Cafeteria Only

7

2

5

North and Cafeteria

4

3

1

Central and Cafeteria

2

2

0

North and Central and

Cafeteria

1

1

0

North and Central

1

0

1

Totals

22

13

line was installed. In the case of the South
and Central Buildings the water lines were
also found to be inadequate to provide pro-
per water pressure at all times. Pipes at the
time of the outbreak were 1% inches in
diameter; 3-inch pipes were installed to
maintain proper pressures. Vacuum break-
ers were installed in the three buildings to
assure protection of water lines.

For sometime, then, a potential hazard
had existed, possibly over a period of many
years. Prior to the present experience, no
incident of waterbome illness could be re-
called. The situation which finally permitted
contamination simultaneously, and appar-
ently independently, by the mixing of drink-
ing and discharge waters within the three
major classroom buildings was not discov-
ered. Inquiry relative to illness in the block
within which the school is located did not re-
veal illness in other inhabitants using water
supplied by the William Street main.

Bacteriologic study of 8 stool specimens
submitted for study by ill patients did not
show presence of pathogenic microorgan-
isms. Millepore filter studies of the con-
firmed positive water sample (outside foun-
tain, South Building) likewise did not show
organisms belonging to other than the Es-
cherichia coli group.

Summary and Conclusions

An outbreak of acute gastroenteritis oc-
curring in 41.4 per cent of the pupils and
teachers of a public school is described. Spe-
cific etiology of the outbreak was not de-
termined.

The incident which brought about suffi-
cient pressure changes within each building
to permit the mixing of drinking and dis-
charge waters was not established, but may
relate to stoppage of a South Building
sewer line.

544

NORTH CAROLINA MEDICAL JOURNAL

December, 1960

Inadequate water pressure, with no pro-
tection against back siphonage was proba-
bly responsible for the mixing of drinking
and discharge waters. It was not possible
to determine precisely when this incident
occurred, but it may have taken place on
September 8.

This outbreak serves to show that despite
the present low incidence of waterborne ill-
ness, health departments should be aware
that such illness may still occur. Sanitation
inspection of public schools should take into
account the fact that outmoded systems may
harbor the hazards found in this outbreak.

Cardiac Fibroma of the Interventricular
Septum in a Newborn Infant

Case Report

Dan P. Boyette, M.D.

Ahoskie

and

J. H. Smith Foushee, M.D.

Winston-Salem

Primary tumors of the heart are exceed-
ingly rare and authors of textbooks on path-
ology usually list them in a short paragraph,
feeling that they need only to be mentioned.
Encountering a large fibroma of the inter-
ventricular septum in a newborn infant is
an experience that we believe should interest
both the clinician and the pathologist. The
purpose of the following case report is to
add another to the short list of primary
heart tumors recorded in medical literature.

Case Report

On August 1, 1957, a 7 pound male infant
was born to a 19 year old Negro primipara.
The pregnancy and labor had both been com-
pletely normal and uncomplicated. The
mother's serologic test for syphilis was neg-
ative.

The infant's respiration was established
immediately upon birth, at which time phy-
sical examination revealed no abnormalities.
He was given the usual newborn care. Two
and a half hours after birth, however, he
became "choked," and was given oxygen for
20 minutes. He apparently recovered, but at
the age of 12 hours he had another "spell"
and was given a small dose of Coramine.
The infant's condition, although not con-
sidered serious at that time, was such that
feedings were not offered.

By the age of 34 hours he had become
cyanotic, and was placed under continuous

From the Roanoke-Chowan Hospital. Ahoskie, and the De-
partment of Pathology, Bowman Gray School of Medicine, and
the Laboratories of Pathology of the North Carolina Baptisl
Hospital. Winston-Salem.

oxygen therapy. Physical examination was
still not remarkable. The lung fields were
clear, and the heart sound were considered
normal. There had been no vomiting, and
mucus was not excessive. At 39 hours, since
he had not responded to oxygen, he was re-
ferred to the hospital for further evaluation
and treatment.

On admission to the hospital the infant
was cyanotic and gasping for breath. He
was placed in an incubator with oxygen and
his color improved somewhat, but respira-
tion was never good. It was thought at that
time that he had moderate atelectasis of the
lungs, but the heart was considered normal,
with no murmurs, enlargement, or arrhyth-
mia. The remainder of the physical examin-
ation was within normal limits.

In spite of much supportive therapy the
infant died three hours after admission to
the hospital, at the age of 42 hours. A post-
mortem roentgenogram of the chest revealed
marked atelectasis of both lung fields, but a
normal cardiovascular shadow.

Autopsy

Autopsy was performed three hours after
death. The positive findings were limited to
the heart and lungs. The heart after fixation
weighed 49 Gm. In the interventricular sep-
tum was a large, firm, circumscribed mass
which measured approximately 4.5 by 4 cm.
The tumor occupied the greater portion of
the lumen of the right ventricle (fig. 1). The
anterior epicardial portion of the mass had
a nodular appearance, and on section the

December, 1960

CARDIAC FIBROMA— BOYETTE AND FOUSHEE

545

Fig. 1. Photograph of the fibroma of the heart
with the tumor incised, lxl.

lesion was found to be gray-white and firm.
On microscopic examination the tumor was
composed of interlacing bundles of connec-
tive tissue, forming a circumscribed mass
(figs. 2 and 3). Focally, there were collec-
tions of lymphocytes present in the mass.
In the Masson's connective tissue stains, the
tumor stained as connective tissue and was
sharply circumscribed from the surrounding
normal cardiac muscle. No capsule was pre-
sent.

Both lungs were extremely hyperemic and
hemorrhagic focally.

Comment

Fibroma of the heart is a benign tumor
which may arise in any portion of the myo-
cardium or cardiac valves. In the 7 cases re-
viewed by Fuhmann"', 5 originated in
either the right ventricle or right auricle.

One of these cases (Wagstaffe's) occurred
in a 3 month old girl who died suddenly.
The tumor was the size of a "chicken egg,"
and arose in the interventricular septum.
The tumor protruded into the lumen of both
ventricles. Our case is similar in that the
tumor arose in the interventricular septum
and extended into the ventricular cavity of
the heart.

Monckeberg'111 reported a fibroma of the
heart in a newborn infant that was present
at the apex of the left ventricle and ex-
tended into the lumen of the chamber.

Kulka'-' reported a case of sudden death
in an 8 month old child who had a fibroma in
the anterior wall of the left ventricle.

Prichard'41 stated, in his review of cardiac
tumors, that owing to a confusion of terms,
it is difficult to state how many tumors of
this type have been reported. Fibromas and
hamartomas are grouped together in his
study. Tumors of the same type arising from
the valve cusps are also recorded.

Microscopically, these fibromas are com-
posed of dense connective tissue. Some that
have been reported in the heart also contain
other tissue such as fat, nerves, blood vessels,
and muscle. According to Prichard, these
tumors are therefore hamartomas.

From the foregoing discussion it would
appear that sudden death is a common out-
come of cardiac fibromas in infants.

Fig. 2. Photomicrograph of the fibroma. Note the
dense connective tissue of which it is composed.
X 142.

Fig. 3. In this photomicrograph, the fibroma of
the heart is demarcated from the surrounding car-
diac muscle. X 142.

546

NORTH CAROLINA MEDICAL JOURNAL

December, 1900

The report of this case of fibroma of the
interventricular septum of the heart in a
newborn infant serves to illustrate one of
the rarer causes of death during the neo-
natal period. Although the tumor itself was
not malignant, its location and size were such
that the vital functions of the heart were
impaired to a point incompatible with life.
(Even if its presence had been suspected,
it is doubtful whether surgery or any other
form of therapy could have effected recov-
ery).

Summary

The case of a newborn infant with fibro-
ma of the interventricular septum is re-
ported. We believe that cardiac fibromas
are probably hamartomas.

It is thought, that the rarity of this occur-
rence merits its inclusion in medical litera-
ture.

Acknowledgement

The authors wish to acknowledge referral of
this case by Dr. Leroy Hand, Jr. of Gatesville,

North Carolina, who delivered and cared for the
child before admission to the Roanoke-Chowan Hos-
pital, Ahoskie, North Carolina. The photographs
were prepared by Mr. Ben Morton.

Addendum

Since this paper was presented to the Medical So-
ciety of the State of North Carolina, Jernstrom
et al'2' have reported another case of intramural
fibroma of the heart in a 3 '4 year old child.

References

1. Fuhmann, F-: Heitrnge zur Casuistik der primaren
Neubildungen des Herzens, Inaugural-Dissertation, Aus
dem pathologischen Institut zu Marburg, Marburg 1899,
p. 17-22.

2. Jernstrom, P., and Cremin, J. II.: Intramural Fibroma of
the Heart, Am. J. Clin. Path. 32:250-256 (Sept.) 1969.

3. Kulka, W. : Intramural Fibroma of the Heart, Am. J.
Path. 25:549-557 (May I 1949.

4. Monekeberg, J. G.: Erkrankungen des myokards und des
spezifischer Muskelsystems in Henke. F. and Lubarseh, O.:
Handbuch tier speziellen pathologist-hen anatomie und
Histologic. Berlin. Springer-Verlog 1924-1939, vol 2. p. 493.

5. Prichard, R. W.: Tumors of the Heart; Review of Subject
and Report of 150 Cases. Arch. Path. 51:98-128 (Jan.)
1951.

Current Trends in the Use of Monoamine Oxidase

Inhibitors in Depression

Arthur J. Prange, Jr., M.D.
Chapel Hill

The purpose of this paper is to report the
results of a survey conducted in June, 1960,
among the physicians of the North Carolina
State Hospitals and the North Carolina Psy-
chiatric Research, Training and Treatment
Center at Chapel Hillf. The survey sought
to determine the relative popularity of six
commercially available monoamine oxidase
inhibitors in the treatment of depression.
This information was considered essential
to select a monoamine oxidase inhibitor for
clinical comparison with other modes of
treatment of depression, my previous exper-
ience having demonstrated the importance
of testing drugs that are popular among the
physicians asked to use them.

One hundred thirty physicians were sent
an explanatory letter and a postcard to re-
turn. Each was asked (1) to assume that he
was confronted with a case of depression

•From the Department of Psychiatry. The University of
North Carolina School of Medicine. Chapel Hill.

tThe author gratefully acknowledges the generous response
of the cooperating physicians.

and had decided not to use electroshock
therapy or imipramine (Tofranil, .Geigy) ;
(2) to assume that he had decided to use a
monoamine oxidase inhibitor, with or with-
out psychotherapy; (3) to indicate by a
check mark which monoamine oxidase in-
hibitor he would select (provision was also
made for the physician to check "no prefer-
ence" or "would never use one"), and (4) to
indicate whether in his experience he had
treated with monoamine oxidase inhibitors
"no cases of depression, less than 10 cases,
or more than 10 cases."

Ninety-five (73 per cent) of the addressees
responded. Two responses were not counted :
one, because the physician's experience was
based entirely on work with children, and
one because three drugs were checked with-
out an indication of preference. Eight re-
spondents checked two drugs without indi-
cating preference ; each of these drugs was
given one-half vote. The responses of the
State Hospital physicians and the Chapel

December, 1960

MAO INHIBITORS— PRANGE

547

Table

1

Table 2

Relative Populari

of Six Monoamine

Relative Popularity of Six M

Dnoamine

Oxyd

ase Inhibitors

Oxidase Inhibitors

(Corrected

Values)

(Uncorrected

Values)

Total Vot

No.
Doctors

No.
Doctors

No.
Doctors

Monoamine

Raw
Vote

Raw
Vote

Raw

Vote

(weighted
for ex-

with no with<10

with> 10 Total

Oxidase Inhibitors

X 1

X 5

X 15

perience)

MAO

MAO

MAO

No.

Catron (beta-phenylis

-

cases

cases

cases Doctors

opropyl-hydrazine )

0

32 y2

112%

145

Catron (beta-phenylis-
opropyl-hydrazine) 0

Marplan

(isocarboxazide) 0

Marsalid

6%
1

7%

0

14
1

Marplan

(isocarboxazide)
Marsalid

(iproniazid)
Nardil (phenelzine)

0

1

5

0

42%

0

0

75

5

0
118%

(iproniazid) 0
Nardil (phenelzine) 1

0

8%

0

5

0
14%

Niamid (nialamide)
No preference

2

21

35
85

165

22 y>

0

202

128%
8

Niamid (nialamide) 2

7

11

20

Would never use one

3

5

No preference 21
Would never use one 3

17
1

1%

0

39 y2

4

27

200

375

602

27

41

25

93

Hill physicians differed only in that the
former, taken as a group, had had somewhat
more experience with these drugs. There
were no consistent differences in the re-
sponses coming from the various hospitals.
Therefore, all responses are considered to-
gether, as shown in table 1.

These data are somewhat more meaning-
ful if weighted according to the experience
of the respondent. Each vote based on "no
cases" has been multiplied by 1 ; on "less
than 10 cases" by 5 ; on "more than 10 cases"
by 15. After discussion with some of the
physicians involved, I have concluded that
the above factors are equitable. A table with
the weighted values is shown below.

Results

Several observations are immediately ap-
parent: (1) In the uncorrected voting, "no
preference" is by far the most frequent
choice. (2) Niamid, Nardil and Catron then
follow in popularity. (3) When the voting
is corrected according to experience (table
2), Niamid is the most popular drug and
Catron and Nardil follow. (4) Of the 95
respondents, none favored Marsalid and
only one favored Marplan.

Comment

Niamid is the most popular monoamine
oxidase inhibitor for the treatment of de-
pression at this time among 95 North Caro-
lina physicians whose practices are limited
to psychiatry. A number of these physicians
have written and informally commented that
they prefer Niamid because of its low tox-
icity. Marsalid and Marplan are rarely
used, and several unsolicited comments
about their high toxicity have been offered.
One physician wrote that he had given
Marsalid to 5 patients and all had developed
"urinary retention." No comments were
offered about the relative effectiveness of
these drugs, and it appears that relative free-
dom from toxicity is the prime determinant
in selection for use. In general, the MAO in-
hibitors appear to be prescribed with
healthy caution.

It must be emphasized that this survey,
to facilitate the selection of an MAO inhibi-
tor a controlled study, attempted only to
identify the most popular MAO inhibitor —
not necessarily the "best treatment" for de-
pressed patients. No inference should be
made concerning the usefulness of MAO in-
hibitors, individually or as a group, com-
pared to such treatments as psychotherapy,
electroshock, or the non-MAO inhibiting
drugs. There is an obvious and urgent need
for reliable data concerning these questions.

The number of patients admitted to public prolonged-care mental hospi-~
tals in this country rose from 150,000 in 1950 to 219,000 in 1959. But the
number of patients resident in such hospitals- has decreased in the last few
years, largely because medical advances have enabled many patients to be
released sooner than was once possible.

548

NORTH CAROLINA MEDICAL JOURNAL

December, 1960

The Ocular Manifestations of Congenital Toxoplasmosis in Five

Out of 686 Cases of Mental Deficiency Examined in a State

Institution for Mentally Retarded Children

Frederick Edward Kratter*
B.Sc, M.D., Ch.B., C.M.D., D.P.M.

Chapel Hill

Toxoplasmosis is an infectious disease
caused by a protozoal parasite of world-
wide distribution. The organism. Toxoplas-
ma gondii, has been known since 1908, when
it was demonstrated in the gondi, a North
African rodent, by Nicolle and Manceaux
and independently by Splendore in the rab-
bit in Brazil. Benda quotes Hellbrugge as
mentioning that toxoplasma apparently had
been discovered in 1900 by Iaveran, in the
blood of a bird. It has since been found to
be an infective agent in a great variety of
species of rodents, mammals and birds from
almost anywhere in the world, providing a
large reservoir for human infection.

Incidence

The rat, mouse, dog, hen, cow, goat, pig,
sheep, and many other animals display host
susceptibility to the toxoplasma parasites,
and serologic evidence indicates that the or-
ganism has been responsible for infecting
between 20 and 40 per cent of the popula-
tion in Britain (Beattie). The incidence of
congenital toxoplasmosis in State Schools
for Mental Defectives in the United States
has been estimated to range from 0.2 to
0.05 per cent.

Pathology

The first cases of proved human infection
were detected in newborn infants by Wolf
and Cowen, in 1937. The crescent-shaped
parasite is usually found in cells, where it
reproduces by fission. It shows a pronounced
preference for the chorioretinal structures
of the eye, where it was observed by Wilder,
Jacobs and others. Hogan was able to iso-
late the parasite from the eye in a case of
congenital toxoplasmosis of 20 years' dura-
tion.

Aggregates of toxoplasma, often referred
to as cysts, have been noted in sections of
the brain, spinal cord, pancreas, lungs, liver,
kidneys, suprarenals, gonads, myocardium,
and skeletal muscles. There the parasites

•Honorary lecturer in mental deficiency. Department of Psy-
chiatry. University of North Carolina School of Medicine.
Chapel Hill: formerly superintendent. Caswell Training School.
Kinston. North Carolina.

may long remain viable in the encysted
stage, sometimes for the life of the host.
The parasites are not infrequently released
from the cyst walls, inducing parasitemia
or localized inflammatory changes and
scars in the uveal structures. This mechan-
ism has been suggested as the means where-
in- recurrent attacks of human toxoplasmic
chorioretinitis are produced.

By means of the cytoplasm-modifying
methylene-blue dye test developed by Sabin-
Feldman, the complement-fixation test and
toxoplasmin skin test, it has been demon-
strated that patients with uveitis yield a
higher proportion of cases with immunologic
evidence of toxoplasmosis than is detectable
in the general population. The fact that
positive findings are recorded in the normal
population shows the widespread incidence
of this disease.

Symptoms

Toxoplasmosis, on the whole, does little
harm in the adult population except in the
acquired form, which may be fatal. The hu-
man fetus, however, is particularly suscep-
tible to the parasites, which display a re-
markable affinity to the central nervous
system. The disease is transmitted at about
the fifth month of pregnancy to the fetus
through the placental circulation from a
mother who has suffered from a recent in-
fection. The manifestations, however, are
usually subclinical, and the disease is rare-
ly recognized. Such a mother may give
birth to a child with signs of hydrocephaly,
mental deficiency, microcephaly, epilepsy,
chorioretinitis, microphthalmia, optic atro-
phy, and muscle paralysis. The mother us-
ually develops immunity to the organism
and rarely, if ever, has two children with
the same disease. The newborn infant may
show additional evidence of active infection
by such signs as hepatomegaly, splenome-
galy, icterus and maculo-papular rash.

There has been much discussion about
the level at which dye titers become of clin-
ical significance. One sees, for example,

D

ecember,

1960

TO

X(

DPLA

SMOSIS-
Table 1

-KRA

Case

Age

Sex

Skin
Mothers

T

1'

est
atient

Dye

5

Test

1

37

F

+

+

+

1:32

3

31

F

*

-)-

+

1.128

2

13

F

+

+

•

1:64

4

12

F

+

+

+

1:64

5

58

M

+

+

+

1:64

549

^Mother not available for skin test.

children with convulsive disorders, micro-
cephaly or mental retardation without sero-
logic evidence of toxoplasmosis, while all
children and adults with central chorio-
retinitis significantly show high dye-test
antibody titers, whether or not other signs
of congenital toxoplasmosis are present.

It is the opinion of Fair and others that
the commonest clinical form of congenital
toxoplasmosis is that in which only the
uveal structures are involved. A varying de-
gree of mental deficit is usually detectable.
Patients with life-long central chorioretin-
itis are frequently accompanied by positive
skin tests and dye tests of rather low anti-
body titers — for example, 1:32, 1:64, and
1:128.

These are the very titers reported in vis-
ually defective and blind patients who suf-
fer from recurrent attacks of toxoplasmic
chorioretinitis unassociated with other clin-
ical signs. Similarly, low titers were also
observed in patients from whose blind eyes
viable parasites were isolated (Jacobs). It
is further held that the eye is capable of
harboring active toxoplasmic lesions with-
out evoking high dye-test antibody titers or
that the titers, after an initial rise, quickly
fall to a moderate level. Low dye-test titers
are thus quite specific for ocular toxoplas-
mosis, and a small, active uveitis within one
or both eyes may suffice to give rise to a
moderate increase in serum antibodies.

Material and Method

A survey of 686 mental defectives aged
16 and younger, and of patients with a his-
tory" of long-standing visual handicap, wks
conducted at Caswell Training School, Kin-
ston, North Carolina in April, 1958. The
team was composed of a consultant ophthal-
mologist and the writer, using the skin tox-
oplasmin test, dye-test, arid ophthalmoscopic
techniques. Signs of the congenital form of
toxoplasmosis with pronounced chorioretin-
al manifestations were detected in 5 mental
defectives, 4 female and 1 male.

Skull Roentgenogram

Small circumscribed areas of
calcification throughout
No abnormal calcifications
No abnormal calcifications
No abnormal calcifications
No abnormal calcifications

Low dye-test titers and positive skin
tests were obtained (table 1), and all pa-
tients had a history of defective vision of
varying degree; 2 patients had convulsive
disorders of the major type and one showed
intracranial calcifications of the diffuse,
small, circumscribed kind.

The 5 cases of congenital toxoplasmosis
represent 0.7 per cent of the 686 patients
investigated and 0.25 per cent of the total
enrolment of 1,930 patients resident at Cas-
well Training School.

Case Reports

Case 1

The patient, a 37 year old white woman, gave a
history of grossly defective vision in both eyes.
She was the fourth of nine siblings, five living
and four dead. She had epilepsy of the major type.
Her father, an alcoholic, died of tuberculosis at the
age of 33. Her mother was still living, and in good
health. The parents were second cousins.

The patient had a record of backwardness at
school. Results of psychometric tests (Stanford-
Binet) were as follows: January 26, 1928 — chrono-
logic age 6-11; mental age, 3-4; intelligence quo-
tient, 48; October 22, 1934— C. A., 13-8; M.A. 6-8;
I.Q. 49; March 5, 1953— C.A. 32, M.A. 7-2, I.Q. 48.

Fundoscopic examination disclosed tremendous
bilateral chorioretinal scars in each macula. In the
right fundus was a large healed scar, strongly
pigmented. There was bilateral horizontal nystag-
mus and internal strabismus involving the right
eye.

X-ray examination of the skull disclosed "small
circumscribed areas of calcification throughout the
cerebral structures."

Reactions to . skin tests (toxoplasmic were
strongly positive in the patient and positive in the
mother. A dye test drawn in April, 1958, was posi-
tive in a dilution of 1:32.

Diagnosis: "A confirmed case of congenital tox^
oplasmosis iri Ja; mid-grade" mentally defective fe-
male, with major epilepsy.

Case 2

The patient,, a 13= year old white girl, was a men-
tal defective of the familial type. Her gait was
awkward, and she had a history of defective vision.
The youngest of three siblings, she weighed 5%
pounds at birih.

550

NORTH CAROLINA MEDICAL JOURNAL

December, 1960

Her mother was a high-grade mental defective,
and both maternal grandparents were also defec-
tive. While imprisoned for murder, the grandfather
died of cardiac disease at the age of 73. The ma-
ternal grandmother had poor general health.

Results of psychologic testing were as follows:
Stanford-Binet; February 8, 1958 — C.A. 12-8, M.A.
3-10, I.Q. 34. Bellevue-Wechsler Scale for children:
full scale I. Q. 33.

Fundoscopic examination revealed bilateral heav-
ily pigmented chorioretinal scars. The anterior
segment of each eye was clear. The left eye showed
an external squint. Roentgenograms of the skull
were essentially negative.

Reactions to toxoplasmin skin tests were strong-
ly positive in the patient, positive in the mother.
A dye test drawn April, 1958, was positive in a
1:64 dilution.

Diagnosis: A confirmed case of congenital tox-
oplasmosis in a mid-grade mentally defective fe-
male of the familial type.

Case 3

The patient was a 31 year old white woman. She
had been born at term, after an uneventful labor,
and weighed 6 pounds at birth. For the first three
months she had had prolonged fits of crying. She
commenced teething at 1 year and walking, with
some difficulty, at 3 years of age. She has never
talked. Her right eye was removed prior to her
admission to Caswell Training School on December
9, 1949. At the time of writing she is almost blind,
stunted in growth, poorly proportioned, and micro-
cephalic (cranial circumference 16% inches). Her
older brother is normal. Parental history is not
available.

Examination of the left fundus showed large
central chorioretinitis. Microphthalmia was noted
in the left eye. The right eye had been surgically
removed. X-ray films of the skull were essentially
negative. Reaction to a toxoplasmin skin test was
positive. The mother was not available for testing.
The dye test drawn April 1, 1958, was positive in
a dilution of 1:128.

Diagnosis: A confirmed ease of congenital toxo-
plasmosis in a low-grade microcephalic mental de-
fective female, associated with microphthalmia in
the left eye and almost complete blindness.

Case 4

The patient, a 12 year old white girl, was the
second of seven siblings. She began walking at the
age of 18 months and talking at 2 years. She had
had the following childhood diseases: whooping-
cough, chicken pox, measles, and mumps. She had
a record of major epileptic seizures since early
childhood.

Results of a psychometric test done on Decem-
ber 21, 1953 were: C.A. 7-7, M.A. 3-10, I.Q. 51. The
report added that the "patient shows extremely
poor visual perception which cannot be improved
with glasses."

Fundoscopic examination showed inactive central
chorioretinitis in both eyes. Each nerve head was
quite pale, but the vitreous body was clear. She
also had an alternating internal squint. Skull
films were essentially negative.

Skin tests done on both patient and mother were
positive. A dye test drawn April 1, 1958, was posi-
tive in a 1:64 dilution.

Diagnosis: A confirmed case of toxoplasmosis in
a high-grade defective female, associated with ma-
jor epilepsy.

Case 5

The patient, a 58 year old white man, was con-
sidered mentally defective by his family, but no
detailed information regarding his development
was available, except that he began walking at 2
years 3 months. He often expressed paranoid
ideas, and on several occasions threatened suicide.
Once he caught the colored maid by the throat,
threatening to kill her. His condition gradually de-
teriorated, and he became temperamentally un-
stable and unmanageable. He is said to have set
fire to a barn when he was an adolescent.

His father had had severe diabetes. The mother,
who is still living, was in good health and men-
tally normal; a maternal aunt, however, had ma-
jor epileptic seizures.

Psychometric tests done July 20, 1945, were re-
ported as C.A. 44-11, M.A. 2-6, I.Q. 20 (on the
Kuhlmann Infant Scale). The psychologist added
that "the patient belongs to the group of persons
generally referred to as pseudo-mentally retarded,
in view of his long history of delusions and hallu-
cinations which are superimposed on a background
of mental retardation. In April, 1953, the patient's
test scores were C.A. 52-7, M.A. 4-1, I.Q. 26. The im-
provement in the score over that obtained in 1945
apparently indicates a lessening of the intensity
of the psychogenic disorder (pfropfschizophrenia)."

Fundoscopic examination of the right eye showed
advanced cortical and nuclear cataract with no
sign of old inflammation externally. "The left lens
was clear. A few small floating exudates were
noted in the vitreous humor and there was a large
central chorioretinal scar."

The patient's reaction to a toxoplasmin skin test
was strongly positive; the mother's positive. A dye
test drawn April 1, 1958, was positive in a 1:64
dilution.

Diagnosis: A confirmed case of congenital toxo-
plasmosis in a mid-grade mentally defective male,
with superimposed schizophrenia psychosis de-
scribed as pfropfschizophrenia.

Conclusion

Congenital toxoplasmosis is an important
etiologic factor in the production of cen-
tral, bilateral chorioretinal lesions, and of-
ten the only clinical sign seen of the dis-
ease ; it is also a prenatal agency in the

December, 1960

TOXOPLASMOSIS— KRATTER

551

causation of mental deficiency of varying
degrees and of developmental anomalies.

It may be added that a mother, having
borne one affected infant, acquires such a
degree of active immunity to toxoplasmosis
that there is little risk of her bearing a sec-
ond child similarly affected. If we had a re-
liable method of combating toxoplasma
infection without hindering antibody-form-
ation, one could recommend the active im-
munization of all toxoplasmin negative

pregnant women as a routine measure of
arresting congenital toxoplasmosis.

The author wishes to express his appreciation
to Dr. J. R. Fair, M.D., Chief, Ophthalmology Di-
vision, Department of Surgery, Eugene Talmadge
Memorial Hospital, Medical College of Georgia,
Augusta, Georgia, for his ophthalmoscopic exam-
inations, serologic studies and advice, and also to
Nurse Rose M. Jordan for her valuable co-opera-
tion and planning of Table 1.

Medical Treatment of Glaucoma

Alan Davidson, M.D.
New Bern

Glaucoma is a disease that is difficult for
the patient to accept and difficult for the
physician to diagnose and manage.

It presents the following problems to the
patient :

It commonly has no early symptoms.
Vision may be almost lost before the disease
is recognized.

It is a test of the patient's faith in his
physician, because frequently the diagnosis
has to be accepted in the absence of sub-
jective symptoms.

It confronts the patient with a lifetime of
inconvenient medication ; of repeated, ex-
pensive, tedious eye examinations, and often
operations.

It requires an intelligent, cooperative pa-
ti ait — a "miotic personality" — for satisfac-
tory medical treatment.

It holds over the patient the ever-present
threat of having to go through life with gun-
barrel vision, or no vision at all.

Glaucoma is difficult from the physician's
point of view (1) because of the lack of
symptoms to aid in early detection; (2) be-
cause of the necessity of an absolutely ac-
curate diagnosis between the angle-closure
and the open-angle types — a feat that at
times is virtually impossible; (3) because
of the lack of a single, simple clinical test
which will accurately follow the course of
the disease; (4) because of the necessity of
estimating the patient's intelligence and co-

Read before the Section on Ophthalmology and Otolaryngol-
ogy, Medical Society of the State of North Carolina, Asheville.
May 10. 1960.

operation before setting out on a medical
regimen; (5) because there is no way of
knowing exactly how much pressure a given
optic nerve will stand; (6) because of the
life-long nature of the disease; (7) and be-
cause there are no hard and fast rules for
the medical or surgical treatment. The reg-
imen of treatment must be tailored to fit the
individual case.

In summary, the patient and the physi-
cian are faced with a disease-process the
main feature of which is a slow but inex-
orable decrease in the outflow facility of the
eye and a rise in the eye's intraocular pres-
sure, causing damage to the optic nerve with
resulting loss of visual field and visual acui-
ty.

This is the problem. What can be done
about it?

My specific subject is the medical treat-
ment of glaucoma. This automatically elim-
inates most cases of the angle-closure type,
of which at least 95 per cent are surgical.
The only medical therapy is that needed to
lower the tension in an acute attack to a
level where it is safe to operate. In my ex-
perience this has not been a difficult problem
since the introduction of Diamox. Intraven-
ous Diamox, together with intensive miotic
therapy, will usually blunt the edge of an
attack. If this combination fails, a retrobul-
bar injection of Xylocaine and epinephrine
will complete the job. To date, I have not
needed intravenous hypertonic urea, al-
though glowing reports of its effectiveness
have been made.

:..-,■_>

NORTH CAROLINA MEDICAL JOURNAL

December, 1960

Diagnosis

The first step in the medical treatment of
glaucoma is early recognition. This is a
problem for the entire medical profession,
especially those engaged in doing the bulk
of routine physical examinations. It is the
duty of ophthalmologists to teach medical
students, interns, residents, and their col-
leagues in practice how to use the tonometer
and to use it routinely in physical examina-
tions.

Once increased intraocular pressure has
been detected, the next step is the differen-
tial diagnosis. Is it angle-closure or open-
angle glaucoma? If it is the angle closure,
the treatment is surgical. If it is open angle,
the control is primarily medical.

The differential diagnosis depends upon
skill and experience in using the gonioprism
and the slit-lamp. With the slit lamp it is
possible to get some idea as to whether the
anterior chamber is roomy or shallow. The
gonioprism will show exactly what is going
on at the chamber angle — that is, if you
know how to use it. I must confess that I am
not confident of my interpretation of what
the gonioprism shows, even after struggling
with it for 10 years. It is an art that re-
quires constant practice, and a skill based
on knowledge of the appearance of the
chamber angle in normal, young adults. Pro-
ficiency is aided by the frequent examination
of normal young eyes. I favor the Allen,
Zeiss, or Goldman apparatus. It is a simple
matter to slip on one of these prisms after
completing a routine examination or treat-
ment at the slit-lamp, such as a contact lens
check-up or the removal of a corneal foreign
body.

Evaluation

Once the differential diagnosis of open
angle glaucoma has been made you are
ready to make a glaucoma survey of both
eyes of the patient. By this I mean:

1. A careful, accurate examination of the
central field using standard tech-
niques and lighting, with a large (3
to 5 mm.) white test object.

2. Ophthalmoscopic examination w i t h
particular attention to the optic disc,
the macular area, and the lens. In
open angle glaucoma, especially with
intravenous Diamox available, you
should dilate the pupils once a year.

Remember, a normal disc can with-

4.
5.
6.
It

stand pressure much better than a
cupped disc.

Schiotz tonometry done at various
hours of the day to map out the pat-
tern of diurnal variation of the intra-
ocular pressure in each individual
case.

Tonography if available.
Gonioscopy.
Visual acuity,
is upon this composite of

tests that

one's clinical judgment is based. However,
there are pitfalls to avoid in interpreting
them.

The visual field can be constricted by
miosis or cataract formation rather than
by glaucoma.

Glaucomatous scotomata can be enlarged
by lens opacities.

Visual acuity can be reduced by cataract,
macular degeneration, or branch occlusion
of the central retinal artery rather than
glaucoma.

Cataract formation can make the optic
disc appear more pink than it actually is,
and early optic atrophy can be missed.

The tonometer may be dirty or out of cal-
ibration. Have at least two good tonometers
available.

An isolated measurement of the intra-
ocular pressure can be very misleading.
Take the tension at various hours of the day
and night. You may be looking at too many
abnormal glaucomatous anterior chamber
angles with the gonioscope. For comparison
study some young adult eyes.

This glaucoma survey should be done com-
pletely, if possible, every 12 months. Exam-
ination of the fields, ophthalmoscopic exam-
ination, and tension and visual acuity tests
can be done as often as indicated, depend. ng
upon the course of the individual case. To
handle any volume of glaucoma cases, stand-
ardized techniques, careful organization of
glaucoma practice, and precise office records
are obvious and mandatory.

Treatment

The principles underlying the medical
treatment of open-angle glaucoma are: the
use of a drug or combination of drugs which
will reduce the intraocular pressure through
out the entire 24 hours of the day to a level
where no damage to the optic nerve wil
occur. This might be 12 or 30 Schiotz unit*
depending on the individual eye. This re
duction should be accomplished by a min-

December, 1960

GLAUCOMA— DAVIDSON

553

imal amount of the drug — as much as neces-
sary, as little as possible. The applications
should be properly timed to take into ac-
count the fluctuations in intraocular pres-
sure during the entire day. The medication
should be adjusted to the patient's daily liv-
ing and emotional status. Without clinical
control, no drug should be prescribed in a
case of open-angle glaucoma.

The aim of medical treatment is to main-
tain the introcular pressure of the eye at a
safe level all day long so that no optic nerve
disease will develop, or if it is already
present, will not progress. This is accom-
plished in the following manner :

Administer a 1 per cent solution of pilo-
carpine three times daily. Pilocarpine is the
smoothest pressure-reducing drug. It causes
less disturbance to the patient's accommoda-
tive mechanism than does any other miotic.
Patients develop tolerance and sensitivity to
it less frequently. If this dosage fails to con-
trol the intraocular pressure (1) increase
the concentration of pilocarpine and the
frequency of dosage; (2) add 0.25 per cent
eserine ointment at bedtime; (3) add 2 per
cent epinephrine bitartrate three times
daily; (4) switch to a more effective miotic:
(5) add Diamox given by mouth, but only
if the patient is too old for surgery, or in
order to keep the intraocular pressure under
control until an operation can be done, or to
keep the tension at a safe level after par-
tially successful surgery ; (6) surgery. Then
if the operation is not completely successful
start the cycle all over again.

The aqueous secretory suppressants — Dia-
mox, Daranide, Neptazane, and Cardrasc- —
have been wonderful aids in treating glau-
coma. In prescribing one of them it is wise
to outline for the patient the various side
effects to be expected. I usually start out
with Diamox, and in the occasional case
where severe side effects occur, switch to
one of the others. There appears to be little
to choose between them so far as therapeu-
tic effectiveness is concerned.

In glaucoma that is not controlled by
other miotics, one of the newer agents
should be tried before resorting to surgery.
Echothiopate iodide (Phospholine) and dem-
ecarium bromide (Humorsol) will bring un-
der control many cases of open-angle glau-
coma uncontrolled by other miotics. My per-
sonal experience is limited to Humorsol. I
have seen no sensitivity reactions to its use.

Large pseudocysts of the iris which ma-
terially interfered with vision developed in
1 patient, and the drug had to be discontin-
ued. It is effective in reducing the intraocu-
lar pressure, and requires only two applica-
tions daily.

Miotics can cause not only an artificial
myopia but also a definite disturbance of the
adaptation of the eye to dark. This can vir-
tually disable the patient and make some
activities, such as driving, dangerous. It
should be kept in mind when prescribing
miotics.

Another phenomenon to remember in pre-
scribing miotics is tolerance. Tolerance can
be distinguished from a change in the se-
verity of the glaucoma by stopping all medi-
cation for three or four days and then re-
evaluating the diurnal variation in intra-
ocular pressure. Tolerance is less apt to oc-
cur if a low concentration of a drug is used
initially.

Conclusioji

In this short paper it is obviously im-
possible to touch on more than a few high
spots in the medical treatment of glaucoma.
One of the most difficult problems is know-
ing when to stop medical treatment and
operate. Light on this subject can be found
elsewhere.

The Duke University
Poison Control Center

J. M. Arena, M.D. Director
ARSENIC POISONING

A 16 month old Negro infant was admitted
to the Children's Ward of the Duke Medical
Center, August 13, 1960, because of a gen-
eralized convulsion and severe vomiting. A
spinal fluid examination done elsewhere was
negative. Because of the continuous vomit-
ing the parents were questioned about toxic
agents and the grandmother confirmed the
fact that the infant had mouthed two or
more bottle caps filled with Terro-Ant Killer
(0.91 per cent metallic arsenic). He was
started on BAL, and after a stormy course
he is making a good recovery.
Comme?it

Arsenic is used in insecticides, ant poi-
sons, weed killers, wallpaper, paint, cera-
mics, and glass. The action of acids on
metals in the presence of arsenic forms ar-

554

NORTH CAROLINA MEDICAL JOURNAL

December, 1960

sine gas, the arsenical analogue of ammonia,
a fantastically toxic gas — 30 parts per mil-
lion by inhalation can give rise to symp-
toms. Arsenic presumably causes toxicity
by combining with sulfhydryl (-Sh) en-
zymes and interfering with cellular oxida-
tive processes. In this respect arsenic be-
haves rather like the heavy metal, although
chemically it is more ambiguous, lying some-
where between phosphorus and antimony,
and in most respects is not metallic at all.
Its soluble compounds are readily absorbed
via the skin and mucous membranes and
only slowly eliminated, so that repeated
doses are cumulative. The fatal dose of ar-
senic trioxide is 120 mg. (2 grains). The al-
lowable food residue is limited by federal
law to 0.65 mg. (1 100 grain) per pound.

The symptomatology depends entirely on
the amount ingested or inhaled. When
massive amounts of arsenic are ingested, the
initial symptoms are violent gastroenteritis,
vomiting and copious watery or bloody diar-
rhea, and burning esophageal pain. Later
the skin becomes cold and clammy. There is
generalized weakness, and the blood pres-
sure falls. Convulsions and coma are the
terminal signs, and death results from cir-
culatory failure. If death is not immediate,
jaundice, oliguria, or annuria appear after
one to three days. Inhalation of arsenic
dusts may cause lassitude, dyspnea, cyano-
sis, cough with foamy sputum, and pulmo-
nary edema.

The general measures in the treatment of
arsenic poisoning are to keep the patient re-
cumbent and warm and to hospitalize him as
soon as possible. Every effort should be
made to remove arsenic from the stomach
by copious lavage, using warm water and
milk (as a demulcent), followed by a saline
cathartic. If the patient is seen immediately
after ingesting the poison, the oral admin-
istration of a mixture of 30 ml. of tincture
of ferric chloride and 30 Gm. of sodium car-
bonate in 120 ml. of water is an effective an-
tidote. Care should be taken, however, to re-
move the resulting precipitate as complete-
ly as possible by gastric lavage. Intensive
hydration should be instituted in order to
maintain fluid balance and to prevent or
treat shock.

The specific treatment is dimercaprol
(BAL) utilized as a general antidote to
sulfhydryl injury by arsenic and heavy

metals. The dosage is 2.5 to 5 mg. per kilo-
gram of body weight by intramuscular in-
jection every four to six hours for two days
and then twice daily for the next 10 days or
until recovery is complete. Children can be
treated in the same fashion, for they toler-
ate BAL as well as do adults. At intervals it
is well to test the urine, stools, and blood to
gauge how rapidly arsenic is being elim-
inated and how effective the course of treat-
ment is.

Aisine

Arsine is an extremely poisonous, color-
less, inflammable gas. It can be evolved
whenever ores contaminated with arsenic
come in contact either with hydrogen ions
from the action of acid on metal, or with
aluminum used as a finely divided wetted
dross (which probably evolves hydrogen by
electrolysis or hydrolysis). Most cases of
arsine poisoning are found in the metallur-
gic industries.

The symptoms are (1) nausea, vomiting,
abdominal cramps; (2) hemolysis, hemo-
globinuria and jaundice; (3) oliguria, anur-
ia, and uremia due to blocking of renal
tubules by products of the breakdown of
hemoglobin.

The toxic effects can generally be ex-
plained by the destruction of red blood cells,
but damage to the liver, spleen, kidneys, t
lungs, and so forth, is also direct and severe.
Electrocardiographic changes are felt to be
of importance in the diagnosis of cases of
even minimal exposure.

Immediate measures are required if the
hemolytic and toxic effects of arsine gas are
to be overcome. Patients receiving sublethal
amount of the arsine will recover without
apparent sequelae. Those receiving a lethal
dose are doomed at a very early hour. Ex-
change transfusion has been advocated.
Dimercaprol, although ineffective, should be
used.

The true solution of the problem lies in
prevention : adequate ventilation, education,
efficient warning devices — these are essen-
tial in any industry where arsine gas is a
possibility. The odor cannot be relied upon
for detection of the gas.

December, 1960

ADVERTISEMENTS

XXIX

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December, 1960

EDITORIALS

555

North Carolina Medical Journal

Owned and published by

The Medical Society of the State of North Carolina,

under the direction of its Editorial Board.

EDITORIAL BOARD
Wingate M. Johnson, M.D., Winston-Salem

Editor
Miss Louise MacMillan, Winston-Salem

Assistant Editor
Mr. James T. Barnes, Raleigh

Business Manager
Ernest W. Furgurson, M.D., Plymouth
John Borden Graham, M.D., Chapel Hill
G. Westbrook Murphy, M.D., Asheville
William M. Nicholson, M.D., Durham
Robert W. Prichard, M.D., Winston-Salem
Charles W. Styron, M.D., Raleigh

Address manuscripts and communications regarding
editorial matter to the
NORTH CAROLINA MEDICAL JOURNAL
300 South Hawthorne Road, Winston-Salem 7, N. C.
Questions relating to subscription rates, advertis-
ing, ect., should be addressed to the Business
Manager, 203 Capital Club Building, Raleigh, N. C.
All advertisements are accepted subject to the ap-
proval of a screening committee of the State
Journal Advertising Bureau, 510 North Dearborn
Street, Chicago 10, Illinois, and/or by a Committee
of the Editorial Board of the North Carolina Medi-
cal Journal in respect to strictly local advertising
accepted for appearance in the North Carolina
Medical Journal.

Annual subscription, $5.00 Single copies, 75<*

Publication office: Carmichael Printing Co., 1309

Hawthorne Road, S.W., Winston-Salem 1, N. C.

December, 1960

POST-ELECTION REFLECTIONS

Regardless of his politics, almost every-
one must have a feeling of relief that the
most strenuous presidential campaign this
country has ever seen is over. Now that the
tumult and the shouting have ended, we may
draw some conclusions in the light of the
cold gray dawn of the morning after.

There seems to be universal agreement
that the campaign was entirely too long.
There is much to be said for the British cus-
tom of allowing only three weeks for a cam-
paign. Certainly, four to six weeks should be
long enough for this country. After the first
month, virtually no new arguments were ad-
vanced and each candidate went over the
same ground ad nauseam. They both must
have been completely exhausted physically
after almost four months of strenuous ex-
ertion.

Neither candidate should have been al-
lowed to expose himself to the actual dan-
gers that they both incurred in their des-

perate efforts to cover every state in the
Union.

It is probably fortunate for the country
that the margin of victory was the narrow-
est since Wilson won over Charles E.
Hughes in 1912. The closeness of the vote in-
dicated that the people are more conserva-
tive than was the Democratic Political Plat-
form Committee. Certainly, Kennedy has no
mandate to launch a lavish spending spree.

It is futile ' interesting to consider the
many if's involved in the campaign. James
Reston devoted a whole column to the if's.
For example, if the make-up man had not
put too much powder on Nixon's face in the
first T.V. debate; if there had been no T.V.
debate at all ; if Kennedy had not telephoned
Martin Luther King's wife, etc., etc. One
comment often made is that it is doubtful if
a majority of either party really wanted
either candidate, but that the choice was
predetermined by the politicians.

For the first time a Catholic was elected
president. It is futile to debate whether
Kennedy was elected because of his religion
or in spite of it. At any rate, the question of
a candidate's religion will probably never be
considered seriously in the future.

There is virtually universal agreement
among editors and political commentators
that our Electoral College system is as ar-
chaic as a muzzle-loading cannon. Certainly,
it is not in keeping with our so-called demo-
cratic form of government for a bare ma-
jority in a state to give a candidate 45 elec-
toral votes. It remains to be seen whether
sentiment will become strong enough to
banish this archaic system.

A final comment is that in spite of the
vigorous campaign waged by both men, it
was a remarkably clean fight. Some com-
mentator said that both Harry Truman and
Lyndon B. Johnson had criticized Kennedy
much more harshly than did Nixon — and
that Republicans had criticized Nixon far
more than did Kennedy.

Kennedy has made an auspicious begin-
ning by asking for a conference with Nixon
and with other leaders of the Republican
Party preparatory to making the transition
as smoothly as possible. This attitude on his
part should leave little encouragement for
Khrushchev, Castro, and company.

A final thought is that conservative
Southern Democrats and Mid-west Republi-

556

NORTH CAROLINA MEDICAL JOURNAL

December, 19(50

cans — re-enforced by some Republican gains
in Congress — will help to keep the ship of
state on a relatively even keel.

MORE ABOUT MEDICAL RESEARCH

The editorial on medical research in the
October issue of the North Carolina Med-
ical Journal provoked a record number of
comments. Space will not permit publishing
all the letters of protest, but one from each
medical school is to be found in the Corre-
spondence Department, Although only those
of protest are published, it is only fair to
say that there has been enough favorable re-
action to balance the scale almost evenly.

It is significant that all the letters of crit-
icism have been from members of the Heart
Association. Since cardiovascular disease is
the leading cause of death, this editor is
quite willing to concede that it should be
given priority over all others. Certainly in
terms of need, the Heart Association has a
far more valid claim to public support than
have the organizations for combating polio,
cystic fibrosis, and any number of rare and
unusual diseases that are now soliciting
funds.

The October editorial was not intended to
discourage giving to such really deserving
causes as the Heart Association. It was
meant as a protest against the multitude of
fund-raising organizations operated for con-
siderable profit by their paid employees, us-
ing all kinds of tear-jerking schemes to raise
money for their own salaries as well as for
research. These organizations are often in
competition with one another and all of
them are in competition with the United
Fund.

Dr. Hal Green's statement that medical
education and research "are not competing
interests but mutually dependent ones," and
that "one cannot be retarded without hurt-
ing the other" is open to debate. In recent
times, many competent authorities have de-
plored the tendency to belittle teaching and
patient-care at the expense of research. For
example in the chairman's address, Section
on Gastroenterology, delivered at the One
Hundred Ninth Annual Meeting of the
American Medical Association, Dr. Joseph
B. Kirsner, said : "The current glamour of
'basic research' notwithstanding, there also
must be renewed attention to the patient as
a person. There is a definite danger, with
the present emphasis upon research and the

apparent de-emphasis of professional skills
and teaching ability, that instruction in clin-
cial medicine will deteriorate."

The conclusion of the whole matter was
expressed by a member of the Heart Asso-
ciation in a personal letter: "I certainly
agree with you that the numerous fund rais-
ing organizations for the rare and unusual
diseases are placing unnecessary and unde-
sirable demands on our citizens. I think the
medical profession must take a lead in some-
how controlling the number of campaigns.
I have thought a lot about this but cannot
come up with an idea as to how we can limit
or restrict the appeals for medical purposes.
Certainly the multiple drives are harming
the research efforts and the standing of the
medical profession."

Let us hope that someone will come up
with the proper idea about limiting and di-
recting appeals for medical purposes.

♦ ♦ ♦

MEDICAL CARE FOR OLDER PEOPLE

As our readers well know, the Forand Bill
and the recent presidential campaign have
made the medical care of our older citizens
a major topic of discussion. In Harper's
Magazine's October supplement, "The Crisis
in American Medicine," one question asked
in the foreword was, "How did both political
parties become convinced that the govern-
ment will have to do something about the
rising costs of medical care for old people?"

The obvious answer is, of course, that
there are 16 million voters aged 65 years or
more. The politicians, who do not consider
whether a majority of the older citizens
themselves want or need government aid,
should profit by a study directed by Pro-
fessor James Wiggins and Helmut Schoeck,
of Emory University's Department of Soci-
ology and Anthropology, and reported last
August to the Fifth Congress of the Inter-
national Gerontology Association. Both the
Rhode Island Journal of Medicine for Octo-
ber and GP for November tell of this study.
The Emory University group, in extended
personal interviews with 1500 noninstitu-
tional persons aged 65 or older, found that
more than 90 per cent of these elderly peo-
ple could think of no unmet personal med-
ical needs; 64 per cent had voluntary med-
ical insurance ; and only 10 per cent believed
that health insurance should be compulsory.

Maybe our older citizens are not as gulli-
ble as the left-wing politicians think.

December, 1960

EDITORIALS

557

THE HARPER'S SUPPLEMENT
Doubtless most of our readers have seen or
heard of the special Supplement, "The Crisis
in American Medicine," published in the
October issue of Harper's Magazine. It is
hardly a coincidence that the National Colle-
giate Debate topic for 1960-61 is : "Resolved,
That the United States should adopt a pro-
gram of compulsory health insurance for all
citizens." While the last six articles discuss
subjects that concern thoughtful medical
men, the Foreword and the first two articles
furnish ammunition for the affirmative of
the query.

Editor R. H. Kampmeier's editorial in the
October issue of the Journal of the Tennes-
see Medical Association is so good that much
of it is quoted below, with permission and
with a hearty Amen !

to medical schools at the moment.) Over the
years and as a member of an admissions
committee your editor has interviewed many
applicants to medical schools . . . My well
formulated opinion based on this experience
is that scientific curiosity is the basic drive
in choosing medicine as a career ... If
scientific curiosity is the motivation for a
medical career, one can readily see why the
'cream of the crop' is by-passing medicine
for electronics, 'rocketeering,' radioactive
science and chemical engineering. With such
stimuli why should a bright boy choose a
medical career to be branded later as dis-
honest, superficial and money-mad? It were
far better to get into electronics, take out a
few patents and drive a Cadillac without
criticism."

"It is with portions of the Foreword, and
the two first articles The Politics of Medicine
and The Decline of the Healing Art that
your Editor wishes to take exception. The
authors have done both the ill of this coun-
try and the public at large a great disservice
through a vicious emphasis on half truths
and uncommon practices, a misinterpreta-
tion of facts, as well as superficial analyses
because of either gross ignorance or perfidi-
ous innuendo.

"It is amazing to what an extent even a
'free' press may reach the effect of a con-
trolled press. The 'herd' reaction of the
writers of the press on the socio-economic
facets of today's medicine is one of the
phenomena of present-day writing. General-
ly, politicians, and writers for the public,
conspire by this mass hysteria to lay all of
the difficult problems of modern medical
care upon the heads of the medical profes-
sion alone.

"Through the creation of an image of the
doctor as a dishonest, superficial, out-dated,
social climbing, money-grabbing charlatan,
the press is doing the people of this country
a grave disservice.

". . . The present attitude of the press may
well influence the shortage of physicians it
laments and blames on 'the most powerful
trade association, (A.M. A.) in the world,'
in its alleged efforts to control the output of
physicians so fees may be kept up. (The
ludicrousness of this viewpoint is apparent
to every medical educator who deplores the
dearth of qualified applicants for admission

THE NORTH CAROLINA MEDICAL
JOURNAL CHANGES PRINTERS

This issue concludes Volume 21 of the
North Carolina Medical Journal. It also
marks the end of the association from the
beginning with the present printing estab-
lishment. For the first seven years of this
Journal's life, the firm was known as the
Penry Aitchison Company. Until his death
in September, 1948, the late Harry Aitchi-
son was "guide, philosopher and friend" to
the editor and his daughter assistant'1 >. A
year after his death the firm's name was
changed to the Carmichael Printing Com-
pany— for the senior partner in the firm,
Mr. Robert Carmichael. He too has taken a
personal interest in the Journal over the
years.

From time to time, as a good business
man should, our Business Manager, Jim
Barnes, has asked for competitive bids for
publication of the Journal. This year the
Graphic Press of Raleigh made the winning
bid ; so the January issue will bear the im-
print of that firm. It has a good reputation
and this editorial office looks forward to a
pleasant association with them. It is but
natural, however, to bid farewell to our
long-time friends, the Carmichael Printing
Company, with a feeling of sadness.

For both the Carmichael Printing Com-
pany and the Graphic Press the best of
everything for the coming year.

1. Editorial: Harry Aitchison, North Carolina M. J. 6:451
(Oct.) 1945.

558

NORTH CAROLINA MEDICAL JOURNAL

December, 1900

President's Message

A MID-YEAR REPORT

By now the first half of my term of stew-
ardship of your State Medical Society is
past. It is in order to bring you up to date,
briefly and concisely, on problems of major
importance and what progress has been and
is being made toward solving them. As a
preamble, however, I would like to give a
personal observation.

The Presidency of your State Medical
Society should no longer be considered as a
reward for services rendered in the past.
The business of any state medical society
has so grown in basic importance, complex-
ity, and volume as to require a major por-
tion of the time, thought and effort of an
interested and intelligent person, if his
presidential duties are to be discharged to
the credit and benefit of the Society. I hope
I am measuring up to the demands of this
exacting job. Thus far, more than one third
of my productive working time has been
spent in this effort. Barring conflicts, I have
attended every major district or county
meeting to which I have been invited or of
which I received notification. I hereby re-
quest the privilege of attending all major
meetings held before my tenure of office ex-
pires in May, 1961. My experiences, thus
far, have been mostly pleasant and reward-
ing and I am thoroughly enjoying the op-
portunities and contacts which the presiden-
cy is affording me.

When given the gavel of office this past
May, I promised to meet existing problems
head on, to seek out areas of detrimental
complacency and propose remedial action,
and also to strive for greater excellency in
the functions and achievements of our So-
ciety. This, I believe, is being done.

Already the programming of our 1961 An-
nual Scientific Assembly is virtually com-
plete. In the pages of this Journal you will
soon receive advance information about the
May Assembly in Asheville which is calcu-
lated to revitalize your interest and deter-
mination to attend. Long before May 8 you
will receive a new type of program which
will contain advance information about the
content of the scientific papers and bio-
graphic information about the speakers.

The decision to abandon the afternoon
specialty section meetings produced much

discussion and discontent. This resultant
discontent and wide discussion have, I be-
lieve, served a good purpose. Renewed and
revitalized interest evidenced in specialty
section meetings has led to the decision by
the Committee on Scientific Works to con-
tinue these meetings on Monday and Tues-
day afternoons for another year. It is hoped
that increased attendance and participation
in these sessions will justify their continua-
tion. Both this Committee and I sincerely
hope, however, that attendance at specialty
section meetings will be secondary to at-
tendance at the entire State Society pro-
gram, including sessions of the House of
Delegates, where we all shall meet as med-
ical doctors with a common interest in a
common cause — the survival of private en-
terprise medicine.

In September the Executive Council ap-
proved the progress made by the Ad Hoc
Committee established by the House of Dele-
gates empowered to organize a corporation
subsidiary to the Medical Society to operate
in the prepaid medical insurance field under
the National Blue Shield emblem. Much
progress has been made towards the com-
pletion of this project so that it may be pre-
sented to the House of Delegates in an im-
mediately workable form next May. It is
extremely important that all delegates be
factually well informed about it, and that
they come to Asheville with an open mind
and the desire to enter into intelligent dis-
cussions leading towards a proper resolu-
tion of the problem. Further progress will
be reported as it is made.

Currently, the problem of integrating Ne-
gro Physicians into the Medical Society of
the State of North Carolina is about in
status quo. Mecklenburg County has appar-
ently clarified its position so as to conform
with the Constitution and By-laws of our
Society. This was evidenced by documents
recently submitted by local Society officials.
The several Negro applicants in Guilford
County failed to reapply for membership
when offered application forms requiring
that they indicate, by their own initiative,
the type of membership which they desired.
In an indirect manner your society was
notified recently that the Old North State

December, 1960

PRESIDENT'S MESSAGE

559

Medical Society (Negro) had reactivated its
committee charged with the solution of the
integration problem. Perhaps this is a good
omen. I intend to make contact with the Old
North State Society with the purpose of re-
newing discussions in this area. Certainly
there will be developments to report before
our annual session in May.

The biggest problem which we presently
face as a group is the position of physicians
in the implementation of the recent legisla-
tion dealing with medical care of the 65
years and older age group. On Sunday, No-
vember 13, the combined committees of this
Society on Chronic Illness and Advisory to
the Board of Public Welfare held a rather
long and informative meeting in Raleigh,
with Dr. Ellen Winston, State Commissioner
of Public Welfare, and portions of her staff.
Out of the ensuing discussions came four
major problem areas requiring decisions.
(1) Shall we as physicians ask for and re-
ceive vendor payments for services rendered
under this bill as implemented? (Discussed
at length on president's page November is-
sue of this Journal) If so, (2) it will be
necessary to establish and present a fee
schedule for services to be rendered; (3)
produce an acceptable definition of medical
indigency; and (4) submit a priority sys-
tem of benefits such as (a) institutional
care, (b) noninstiutional benefits such as
office visits, home visits, provision of drugs,
and hospital outpatient services.

By the time this article is published the
Executive Council will have met in called
session on November 28, and I assume that
an acceptable answer to these propositions
will have been worked out and submitted to
the proper governmental agency in order
that implementation may be started in the
form of presentation of budget figures to
the Advisory Budget Commission. You will
receive a progress report on this operation
soon, perhaps in the next Public Relations
Bulletin or the President's Message of the
January issue of this Journal.

There is another important area of pro-
gress to be reported to you. The Medical
School of the University of North Carolina
is commencing to implement the "Sanger Re-
port," which was a major factor in the es-
tablishment of this school. This will be the
subject of an entire President's Message in
a forthcoming issue of the Journal. I would
like for all of you to write to the Medical
Care Commission, P. 0. Box 1880, Raleigh,

North Carolina, and request a free copy of
this report. Of particular pertinence to the
background and understanding of this up-
coming article are pages 18-32 inclusive.

I close this report with a sincere wish for
you, your wife and family to enjoy a very
happy Christmas season and a prosperous
and healthy New Year.

Amos N. Johnson, M.D.

CORRESPONDENCE

To the Editor:

I have read with some dismay your edi-
torial in the October number of the Journal
entitled "Medical Research, Choked by
Dollars." This editorial, based in part upon
an article by Mr. John M. Russell which ap-
peared in the October issue of Harper's
magazine, may have unfortunate effects up-
on the efforts of various fund-raising organ-
izations to obtain support for medical re-
search. I am very fearful that your editorial,
as well as the article by Mr. Russell, may be
misinterpreted by the general public.

As a member of the Research Policy and
Allocations Committee of the North Caro-
lina Heart Association. I am particularly
concerned about the possible effects of your
editorial. Perhaps a few facts concerning
the North Carolina Heart Association would
be in order. During the past year our Re-
search Committee received 49 applications,
rejected 10 of these requests, and granted
35. There were 4 applications for projects
which the Committee considered worthy of
support, but for which no funds were avail-
able. Of the 35 grants awarded, most of
these were for amounts which, of necessity,
were less than those requested by the inves-
tigators.

The North Carolina Heart Association
grants are limited to ^2000 for each project
and are considered "seed" money to support
research which may prove worthy of more
detailed investigation, to support a post-
doctoral scientist just beginning a research
career, or to provide interim support for
projects by established research workers. I
am certain that it cannot be said of the
North Carolina Heart Association that our
research program is being "choked by
dollars." I am very fearful that your editor-
ial may have a very serious effect upon the
success of the forthcoming campaign to ob-

5K0

NORTH CAROLINA MEDICAL JOURNAL

December, 1960

tain support for the North Carolina Heart
Association. I sincerely hope that in the near
future you may see fit to show the other side
of the research coin.

J. Logan Irvin

Chairman, Research

Policy and Allocations

Committee

North Carolina Heart

Association

* * *

To the Editor:

I read your editorial in the October issue
of the North Carolina Medical Journal on
"Medical Research Choked by Dollars". I
know John Russell and have participated in
several meetings with him. He is a man of
unquestioned integrity and is dedicated to
improving medical education. I would agree
that he has first-hand knowledge on the sub-
ject about which he writes. He has an entree
to any medical school in the world, with the
possible exception of those behind the Iron
Curtain.

I am sure that the unprecedented expan-
sion of medical research has resulted in
many areas of undesired and possibly un-
necessary waste. Rapid growth in any area
is likely to be associated with apparent
waste. Articles such as that by Mr. Russell
cause one to pause and take inventory. I am
sure, however, that such an article will be
misinterpreted by many people, both in and
out of the medical profession.

The reason for my writing is simply to
point out that we have a meeting scheduled
for tomorrow in Dr. Stead's office to discuss
how we can meet the critical shortage of
funds in our cardiovascular laboratory in
the Department of Medicine. We are hopeful
that our programs will not suffer and that
the projects in progress in the laboratory
will not have to be curtailed. The financial
status of the research program in the car-
diovascular section, however, is at present
critical and we are unaware of being choked
by dollars. Last week I loaned supplies to
Dr. Madison Spach for use in his Pediatric
cardiovascular research laboratory which I
hope will tide him over a similar financial
recession'. He is unaware of being "choked
by dollars." We Will not try
projects in our laboratory,
cance must be determined by
unaware of "terrific waste"
to%v

to justify the

Their signifi-

others. We are

in our labora-

I trust that the forthright and well-
meaning comments of Mr. Russell will make
us pause and re-evaluate our programs. I
trust that they will not result in interrup-
tion of the logarithmic growth curve on
which medical research is now located. I am
fearful that his thought-provoking article
will be misinterpreted and have a deleter-
ious effect on the current rapid progress
that is being made.

Henry D. Mcintosh. M.D.

* * *

To the Editor :

I am writing you regarding the editorial
"Medical Research Choked by Dollars" in
the October Journal.

I have served as a member of the Re-
search Policy and Allocations Committee of
the North Carolina Heart Association for
two years, as a member of the American
Heart Association Research Committee for
five years and as a member of the Physiol-
ogy Study Section of the National Institutes
of Health for three years.

At the meetings of these groups, all of the
grant requests are carefully screened by ex-
perts in the various fields and all grants are
declined outright where it is apparent that
there would be unjustified duplication of
work, or where it is apparent from the in-
vestigator's past record that he cannot use
wisely the monies he has requested. Fre-
quently the remaining meritorious grant re-
quests have been reduced in amount in order
to give at least some support to as many in-
vestigators as possible. Even with the re-
duction, frequently only one half to two
thirds of the meritorious requests could be
awarded. Even at the last meeting of our
North Carolina Heart Association Research
meeting, we found ourselves with over
twenty meritorious requests but were able to
support only half of these because of lack of
sufficient funds.

Mr. Russell sees volunteer agency and
Federal treasuries sending out choking
waves of dollars. Yet with the above knowl-
edge in mind, it is obvious that at least in
my fields of interest, there are young scien-
tists of promise with insufficient means "of
pursuing careers in medical research, and
established medical scientists blocked by in-
sufficient money from following fruitful
ideas for the solution of disease problems.

We need more money for the improvement
of medical education and for research! These

December, 1960

CORRESPONDENCE

561

are not competing interests, but mutually
dependent ones. One cannot be retarded
without hurting the other. In the last twenty
years, tremendous progress has been made
in medicine — thanks to research. It would be
a major setback to halt this impetus now by
curtailing research funds, particularly when
prospects are good for major accomplish-
ments in many directions.

In the long run, all of us will be the bene-
ficiaries of increased — not decreased — med-
ical research.

Harold D. Green, M.D.
The Bowman Gray
School of Medicine of
Wake Forest College

IMAGINARY POVERTY
To the Editor:

Your notes on "Imaginary Poverty" in the
October issue of the Journal close with Dr.
Beatson's queries about prevalence and treat-
ment.

In Eugen Bleuler's careful description of
the depressive psychoses, in his famous text-
book'1', he shows that delusions of disease,
of sin and of poverty are frequently part of
the clinical picture. In my experience delu-
sions of poverty affecting the wealthy are
often part of the clinical picture of a de-
pressive psychosis in North Carolina. Such
patients often also suffer from insomnia and
blame themselves for imaginary misdeeds
for which their imaginary poverty or phy-
sical malaise is looked upon as punishment.
It is essential that such patients secure ade-
quate sleep as part of the treatment pro-
gram. Moreover, an important aspect of
their management is often to safeguard
them against the risk of suicide. Because of
the need for adequate nursing care and ob-
servation, these patients usually require
treatment in hospital. Emergency psycho-
therapy often requires to be supplemented
by electroshock therapy. With such patients
my experience with so-called anti-depressant
drugs has not been encouraging, whereas in
general the response to E.S.T. is favorable.
During the course of E.S.T. they require
especially close observation — for this reason
too they are appropriately dealt with as in-
patients. At first, the risk of suicide may be
enhanced before recovery.

Human beings of all cultures are subject
to loss of loved ones, of youth, of physical
health and of material possessions. Grief is
thus a universal phenomenon among mor-
tals. Since everywhere too ambivalence and
guilt of varying degrees of severity are pre-
valent, some people react with severe de-
pressive illness. Depressive psychoses with
features similar to those described by Bleu-
ler are of world-wide incidence. In my ex-
perience in this country, in United Kingdom,
and in India, I have encountered many
wealthv patients of diverse racial, cultural
and educational backgrounds who have been
rfnicted with "imaginary poverty" as part
of a depressive psychosis.

It should be added that this symptom is
r^ore conspicuous under those cultural con-
ditions, as in Switzerland where Bleuler de-
scribed it, where there is general preoccu-
pation with wealth, and where money and
prestige are closely associated. Banking and
excessive concern with cleanliness, for ex-
ample, are outstanding characteristics,
among others, of Bleuler's native country.
As was originally outlined by Freud'-1, some
people are characteristically excessively- con-
cerned about their possessions. With such
people, in the event of a depressive psycho-
sis, delusions of poverty are more often con-
spicuous. Perhaps this emphasizes needless-
ly the fact that money does not confer men-
tal health, and that as your preceding edi-
torial comment indicates there can be too
much money.

D. Wilfred Abse, M.D.
U.N.C. School of
Medicine

References

1. E. Bleuler. Textbook of Psychiatry, translated by A. A.
Brill, The MacMillan Co., New York, 1924.

2. Sigmund Freud. Character and Anal Erotism, Collected
papers. Vol. II, Hogarth Press, London, 1924.

Mead Johnson Releases New Film

The concentric wavelets that flow outward when
a stone is thrown into a pool symbolize the doctor's
key relationships with the world arounr! him in a
new filmstrip of Mead Johnson's Management Prin-
ciples in Medical Practice series.

It is the latest in the series of 30-minute animated
filmstrips designed to assist young physicians in
setting up and managing a practice. The strips are
shown on request to medical schools, hospital teach-
ing centers and other interested medical groups by
specially trained Mead Johnson representatives.

562

NORTH CAROLINA MEDICAL JOURNAL

December, 1960

BULLETIN BOARD

COMING MEETINGS

Duke University Medical Center, Lectures on Oph-
thalmology— Eye Clinic, Duke Hospital, Tuesday
evening's, 7:30 p.m.

University of North Carolina School of Medicine,
Postgraduate Course in Medicine — Edenton, Wednes-
days, beginning January 11; Kinston, Thursdays,
beginning January 12.

Governor's Conference on Occupational Health —
Raleigh, January 26.

Conference of North Carolina County Medical
Society Officers and Committee .Members — Pinehurst,
January 28.

Watts Hospital Symposium — Durham, February
3-4.

North Carolina Mental Health Association, An-
nual Meeting — Raleigh, February 17-18.

Forsyth County Cancer Symposium — Winston-
Salem, March 9.

Medical Society of the State of North Carolina,
Annual Meeting — Asheville, May 6-10.

Southeastern Surgical Association — Deauville Ho-
tel, Miami Beach, Florida, March 6-9.

New Orleans Graduate Medical Assembly — Roose-
velt Hotel, New Orleans, March 6-9.

New Members of the State Society

The following physicians joined the Medical
Society of the State of North Carolina during the
month of November, 1960:

Dr. Scott Bruce Berkeley, Jr., 712 Simmons Street,
Goldsboro; Dr. John Dillard Workman, 505 Harding
Avenue, Kinston; Dr. David Louis Whitaker, 1701
Queens Road, Kinston; Dr. Robert McClain Jamison,
300 Center Church Road, Leaksville; Dr. Nicholas
William Sacrinty, 120 Monroe Street, Leaksville;
Dr. Thomas Ward Kitchen, Jr., Lenoir; Dr. George
Douglas Kimberly, 108 Main Street, Bakersville.

News Notes from the Bowman Gray
School of Medicine

Four faculty members of the Bowman Gray School
of Medicine were recently elected to the Society for
Experimental Biology and Medicine. *

They are Drs. Richard L. Burt, professor of
obstetrics and gynecology; Thomas B. Clarkson,
associate professor of experimental medicine; Hugh
B. Lofland, assistant professor of biochemistry; and
Norman M. Sulkin, William Neal Reynolds Profes-
sor of Anatomy.

* -+ * •

Dr. Charles M. Howell, Jr., assistant professor
of internal medicine (dermatology and allergy),
presented a scientific exhibit on the "Systematic
Management of Pruritus with Methdilazine Hydro-
chloride" at the Southern Medical Association meet-
ing, October 31 to November 4, at St. Louis, Mis-
souri.

Dr. Weston M. Kelsey, professor of pediatrics,
was chosen president-elect of the North Carolina
Pediatrics Society during a November meeting at
Greensboro.

The Bowman Gray School of Medicine has re-
ceived a $16,500 grant from the Charles F. Ketter-
ing Foundation for the continuation of studies in
photosynthesis. Receipt of the grant was announced
recently by Dr. C. C. Carpenter, dean of the medical
school, and Dr. Frank H. Hulcher, assistant pro-
fessor of biochemistry and principal investigator in
the project.

Dr. Hulcher said the funds will be used to pur-
chase equipment which will aid in a study of the
role of cytochromes in the photosynthetic process.

* * *

Prof. Hermann J. Muller, Nobel laureate in phy-
siology and medicine, spoke recently at the Bowman
Gray School of Medicine on "Radiation Damage in
the Light of Genetics." The University of Indiana
professor's visit was sponsored jointly by the
school's committee on Medical Education in National
Defense and the Student American Medical Associa-
tion.

Dr. Walter J. Bo, associate professor of anatomy,
presented "Relation of Vitamin A Deficiency and
Estrogen in Producing Uterine Metaplasia" at a
LTniversity of Illinois symposium, November 7 and
8. The symposium on metabolism and function of
the fat-soluble Vitamins A, E and K was co-spon-
sored by the National Vitamin Foundation and the

University of Illinois.

* * *

Dr. William H. Boyce, professor and chairman of
the Department of Urology, was a guest participant
in the James C. Kimbrough Urological Seminar at
Walter Reed General Hospital, November 3 to 5, at
Washington, D. C. He participated in panel discus-
sions on the "Diagnostic Problems in Urologic
Roentgenography" and "Therapeutic Problems in
Urology" and presented a movie he had prepared
on the "Advances in the Surgery of Renal Calculi."

On November 7, Dr. Boyce lectured to students
and faculty of the University of Virginia School of
Medicine on "Non-dialyzable Substances in Normal

Human Urine."

* * *

Faculty members participating in the annual meet-
ing of the North Carolina Division of the American
Cancer Society, November 5 and 6, at Raleigh -were
Drs. Isadore Meschan, professor of radiology;
Robert W. Prichard, associate professor of pathol-
ogy; Harry M. Carpenter, assistant professor of
pathology; and John C. Pruitt, research associate
in pathology. Dr. Meschan spoke on tumor regis-
teries in North Carolina, Dr. Prichard on cancer
quackery and Drs. Carpenter and Pruitt spoke on

cancer immunity.

* * *

Dr. Joseph S. Keenan, instructor in speech (oto-
laryngology), presented "Oral-pharyngeal Correla-

December 1960

BULLETIN BOARD

563

tives of Speech Characteristics in Adults with Un-
repaired, Incomplete Cleft Palates," November 2, at
the annual convention of the American Speech and
Hearing Association in Los Angeles, California. Dr.
Keenan also presented papers on stuttering at the 12
annual Conference on Education for Exceptional
Children, November 17 and 18, at Greensboro.
* * *

Training Program in Radiation Biology and
Cancer-Related Research

The Bowman Gray School of Medicine is begin-
ning a training program in Radiation Biology and
Cancer-Related Research. One, two, and three year
traineeships are being offered to research oriented
people in the basic and clinical sciences. The trainee-
ships are being offered both at pre-doctoral and
post-doctoral levels, and stipends will range from
$1,800.00 to $8,000.00 per annum.

It is believed that this program will represent an
excellent opportunity for young men interested in
research to learn radiation methodology and tracer
techniques. A two-part course is offered for the first
year trainees. One part is given in didactic lecture
form, and consists of a rather detailed survey of the
body of knowledge in radiation biology as related
to cancer research. The other part is a survey of
the techniques used in actual laboratory investiga-
tion, and is taught mainly by demonstrations. The
first year trainee will be expected to spend a good
part of his time in the laboratory learning the tech-
niques which most suit his field of interest. Second
and third year trainees will be given the oppor-
tunity to do more advanced and independent re-
search, employing radiation methods in his own
chosen field of interest.

Applications for the training program are being
accepted now for beginning in January of 1961.
and will be accepted until April 15, 1961 to begin
July 1, 1961. All inquiries may be directed to Donald
J. Pizzarello, Executive Director, Radiation Biology
and Cancer Related Research Training Program,
Bowman Gray School of Medicine, Winston-Salem.
North Carolina.

News Notes from the University of
North Carolina School of Medicine

The University of North Carolina School of Medi-
cine has been awarded $897,528 by the National
Institutes of Health for establishment of a clinical
research facility.

Announcement of the award, which will cover a
three-year period, was made recently by Dr. W.
Reece Berryhill, dean of the School of Medicine. Dr.
Berryhill said the new research unit would be di-
rected by Dr. Walter Hollander, Jr., assistant pro-
fessor of medicine and Markle Scholar in medical
science. Dr. Hollander is a graduate of the Harvard
School of Medicine and has been on the UNC
faculty for four years.

Under this grant, the School of Medicine will have
a type of research facility not hitherto possible per-
mitting intensive study and treatment of all types
of patients.

Plans are under way to have the unit opened by
next spring or early summer. For the first several
years, it will temporarily occupy one floor of the
south wing, which was made possible because the
Department of Psychiatry voluntarily agreed to
release the space for this purpose. A permanent
location for the new facility will be arranged at a
later date.

Patients will be treated in the research facility
without any charges, either for hospital room or for
professional services. Patients will be admitted on
a volunteer basis provided their illness is one which
is under investigation in the research programs of
the School of Medicine.

The staff for the new facility, to be named later,
will be the same as that of a regular general hospi-
tal ward supplemented by research nurses and other
specialized personnel required for the more intense
observation and study of these patients.

The facility will open with 10 beds for patient
care, all to be located in private or semi-private
rooms. This will eventually be increased to 12 to 15

beds.

* * *

Two appointments and one promotion have been
announced in the School of Medicine by Chancellor
William B. Aycock.

Dr. David F. Freeman has been named assistant
professor in the Department of Psychiatry of the
School of Medicine, effective next year.

A native of Raleigh, Dr. Freeman received his
undergraduate education at Wake Forest College,
and his medical degree was awarded by the Bowman
Gray School of Medicine in 1951. He has served with
the North Central Mental Health Consultation Ser-
vice, Fitchburg. Massachusetts; Waltham (Massa-
chusetts) Hospital and the Douglas A. Thorn Clinic
for Children of Boston.

Francis Byers de Friess an expert in radiological
physics, has been appointed research associate in
the Department of Radiology of the School of Med-
icine. He joins the staff from the Columbia-Presby-
terian Medical Center of New York City.

Dr. Joseph K. Spitznagel has been promoted from
assistant professor to associate professor in the
Department of Bacteriology of the School of Med-
icine. He is a U. S. Public Health Service Senior
Research Fellow and has been a member of the

faculty since 1957.

* * *

Approximately 75 physicians from throughout the
state and a number from South Carolina and Vir-
ginia attended the U.N.C. Medical Symposium in
Chapel Hill, November 17 and 18.

Participating on the program were Dr. Eddy D.
Palmer, Lieutenant Colonel, Brooke General Hospi-
tal, Fort Sam Houston, Texas; and a number of
faculty members from the three medical schools in

the state.

* * *

A two-state "hospital development program" was
held at the University of North Carolina in Chapel
Hill Monday and Tuesday, November 28 and 29,

564

NORTH CAROLINA MEDICAL JOURNAL

December, 1960

sponsored by the North and South Carolina Hospi-
tal Associations.

Dr. Robert R. Cadmus, director of N. C. Memorial
Hospital, is president-elect of the association and
presided at one of the sessions, which was addressed
by Prof. Claude George, assistant dean of the
U.N.C. School of Business Administration.

* ■{■• ■-:■■

The University of North Carolina School of Med-
icine staged four 30-minute weekly television pro-
grams which began Thursday, November 10 and
which followed the general theme of "A Report to
the People from the School of Medicine."

The series was seen over the UNC television sta-
tion, WUNC-TV, Channel 4, each Thursday at 9:30
P.M.

The National Society for the Prevention of Blind-
ness sponsored an Eye Health Workshop which was
held at the School of Medicine of the University of
North Carolina on November 30.

Of interest to public health nurses and teachers,
principals, school supervisors and education person-
nel throughout western North Carolina, the work-
shop is the first of its kind to be held here.

Mrs. Mary Metlar of the State Board of Health
in Raleigh presided over the meeting, and W. P.
Richardson, M.D., assistant dean for Continuation
Education, gave the welcoming address. Special
speakers included: Maxwell Morrison, M.D. resi-
dent in ophthalmology; S. D. McPherson, M.D., head
of the ophthamology division; and Helen Gibbons of
the National Society for the Prevention of Blind-
ness.

During the afternoon a special session on the
demonstration and evaluation of school vision
screening methods was discussed.

* * *

Dr. T. Franklin Williams, assistant professor of
preventive medicine and medicine addressed the
annual meeting of the Association of American
Medical Colleges at Hollywood Beach, Florida re-
cently. His subject was "The Referral Process in
Medical Care and the University Clinic's Role."

Other faculty members attending the annual meet-
ing, were: Dr. W. Reece Berryhill, dean; Dr. Wil-
liam L. Fleming, professor of preventive medicine
and medicine and assistant dean for education and
research; and Dr. Carl Anderson, professor of bio-
chemistry and nutrition and assistant dean for stu-
dent affairs.

The paper that Dr. Williams presented was pre-
pared by himself; Dr. Kerr L. White, associate pro-
fessor of preventive medicine and medicine and Dr.
Bernard G. Greenberg, professor of biostatistics,
UNC School of Public Health.

* * *

Women delegates from some 40 Tar Heel hospitals
participated in a one-day symposium in Chapel Hill
recently sponsored by the Women's Auxiliary of N.
C. Memorial Hospital of the University of North
Carolina.

The theme of the symposium was "The Functions
of the Hospital Volunteer in the Community and in
the Hospital." The purpose of the meeting was to
have an exchange of ideas that would be mutually
helpful to all hospital volunteer groups.

Speakers were Major L. P. McLendon of Greens-
boro, past president of the Medical Foundation of
North Carolina; Dr. Paul Whitaker of Kinston, al-
so past president of the Medical Foundation of
North Carolina; and Dr. Robert Cadmus, director
of N. C. Memorial Hospital.

Their talks were followed by five separate group
discussions.

The day-long meeting closed with a tour of
various areas of N. C. Memorial Hospital where
volunteers work. The tour was under the direction
of Mrs. V. A. Hill of Chapel Hill.

News Notes from the Duke University
Medical Center

Dr. Wiley, Dr. Forbus, professor and former chair-
man of the Duke University Medical Center's De-
partment of Pathology, has accepted an assignment
to head the reorganization of a medical school in
Indonesia.

On leave from the Duke faculty, he will spend
the next two years at the medical school of Airlang-
ga University in Surabaja, located near the eastern
end of the island of Java.

Dr. Forbus will serve on the University of Cali-
fornia staff as director of that institution's program
to rehabilitate the Indonesian medical school.

The project will be conducted by the University
of California under contract with the International
Cooperative Administration, part of the United
States' foreign aid program.

The Duke pathologist will be chief of party for
the undertaking and will direct a staff of some 15
American medical educators. Also, he will be advisor
on medical education to the dean of the Airlangga
University medical school.

Dr. and Mrs. Forbus will leave Durham on Dec.
15 and are scheduled to return in January, 1903.
Dr. Forbus will continue his academic duties at
Duke from that time until his retirement from the
faculty on Sept. 1, 1963, at the age of 69.

Federal funds of approximately $1 million have
been allotted for the Airlangga medical school pro-
ject. Facilities will be improved, and the curriculum
revamped along the lines of American medical
education. Established in 1911, the school has an
enrollment of some 1,000 students.

Dr. Forbus' new assignment will mark his third
venture in Far Eastern medical education.

During 1953-54, he reorganized the pathology de-
partment and initiated an over-all medical school
curriculum reorganization at the University of
Taiwan, Formosa, as part of the U. S. government
mission to Free China.

Four years ago, he served in a similar capacity
at Keio University in Tokyo, Japan, under auspices

December, 1960

BULLETIN BOARD

565

of the Rockefeller Foundation and the China Med-
ical Board,

Also, he has surveyed medical education in the
Orient for the China Medical Board and has visited
U. S. Army hospitals in the Far East as a consul-
tant to the Army Surgeon General.

One of the original faculty members of the Duke
Medical Center, Dr. Forbus headed the pathology
department from 1930 until he relinquished the
chairmanship this year.

Duke University medical researchers have deve-
loped a new laboratory technique that offers a
practical approach toward conquering cancer of the
cervix.

The technique uses movie film and plastic spray
instead of conventional glass slides to mount speci-
mens for study under microscopes. Specimens are
placed on the transparent 35 mm. leader film and
then sprayed with plastic for protection.

Originators of the process are John Phillip
Pickett of the Duke Medical Center's pathology
laboratory staff and Dr. Joachim R. Sommer, as-
sistant professor of pathology.

Duke University's expanded program of nursing
scholarships has entered its second year, with ap-
plications for the 1961-1962 competition now being
accepted.

Purpose of the scholarships is to encourage young-
women who give promise of becoming leaders in the
field of nursing, according to Robert L. Thompson,
executive secretary of the University Scholarship
Committee.

Financial need is not a factor in making the
awards, Thompson explained, but the stipend as-
signed to each winner will vary according to the
financial circumstances of the recipient.

Any student who has been accepted for enrollment
as a freshman in the School of Nursing is eligible
to enter the scholarship competition.

Application forms must be submitted to the
School of Nursing before February 1, 1961.

Forsyth County Medical Society

The Forsyth County Medical Society held its
regular monthly dinner meeting in Winston-Salem
on November 8. Dr. Jesse Meredith of the Bowman
Gray School of Medicine spoke on "Surgery in
Russia Today."

Tenth Annual Symposium on Cancer

The tenth annual Symposium on Cancer sponsored
by the Forsyth County Medical Society and the
Forsyth County Cancer Service will be held at the
Robert E. Lee Hotel in Winston-Salem on March 9,
1961.

Participants in the symposium will include Drs.
Cyrus C. Erickson, professor of pathology, Univer-
sity of Tennessee School of Medicine, Memphis;
John C. Hawk, Jr., director of the Cancer Clinic,
Medical College of South Carolina, Charleston;
Stuart W. Lippincott, senior pathologist to Research
Hospital, Brookhaven National Laboratory, Upton,
Long Island, New York; George E. Moore, director
of Roswell Park Memorial Institute, Buffalo, New
York.

North Carolina Radiological Society

At the fall meeting of the North Carolina Radi-
ological Society the following officers were elected:
president — Dr. I. Meschan, Winston-Salem; presi-
dent-elect— Dr. Owen W. Boyle, Greensboro; secre-
tary-treasurer— Dr. A. B. Croom, High Point.

North Carolina Kidney Disease
Foundation

The North Carolina Kidney Disease Foundation
for nephritis, nephrosis, and allied kidney diseases
is accepting applications for research grants from
investigators in North Carolina. Applications, which
may be obtained from the Medical Advisory Board
of the chaper, must be completed and sent to the
Board on or before February 1, 1961.

The grants will be made to support both basic and
applied research in the field of nephrosis, nephritis,
and allied kidney disorders. They are designed to
help investigators test new ideas, to provide needed
equipment, or to assist in established research pro-
grams. For the present, only applications for less
than $1,000 will be considered.

For further information and application blanks,
address all inquiries to Jerome S. Harris, M.D.,
Chairman, Medical Advisory Board, Duke Univer-
sity Medical Center, Durham, North Carolina.

Edgecombe-Nash Medical Society

The Edgecombe-Nash Medical Society met in
Rocky Mount on November 10 in conjunction with
the Fourth District Medical Society.

Pediatric Research Institute Chartered

The chartering of Wrightsville Pediatric Research
Institute, Inc., as a non-profit corporation was an-
nounced recently by Mr. Thomas H. Wright, Jr.,
chairman of its Board of Trustees. Financing of
the corporation's research activities has been pro-
vided for in the recent establishment, by an anony-
mous donor, of a $1,000,000.00 charitable foundation.
The new facility, operating under the name Babies
Hospital Research Center, will occupy a building to
be constructed with funds given by Babies Hospital,
Inc., and Dr. J. Buren Sidbury. Matching funds for
construction and equipment will be sought from the
medical research program of the federal govern-
ment.

The Babies Hospital Research Center will be
located near, and operated in close conjunction with,

566

NORTH CAROLINA MEDICAL JOURNAL

December, 1900

the Babies Hospital at Wrightsville Sound. As an
established center of pediatric medicine and surgery,
the hospital attracts a wide variety of patients from
a large geographic area, and the availability of such
a variety of cases for study will be mutually ad-
vantageous to the research facility and to the
patients themselves.

The staff of the Babies Hospital Research Center
is expected to include a director of research, an as-
sistant director, a number of laboratory technicians,
and other personnel. The center will be managed
by a board of trustees whose membership will in-
clude: Mr. Thomas H. Wright, Jr., chairman; Dr.
Louis K. Diamond, Children's Hospital, Boston,
Massachusetts; Mr. Lawrence Lewis, Jr.; Mr. Peter
Browne Ruff in ; Dr. Donald B. Koonce; Mr. S. L.
Marbury; Dr. Rowena S. Hall; Mr. Daniel H. Pen-
ton; Mr. Edward G. Lilly, Jr.; Mr. Robert A. Little;
Dr. Joseph W. Hooper, Jr.; Mr. Walker Taylor,
Jr.; and Dr. J. Buren Sidbury.

New Orleans Graduate
Medical Assembly

The New Orleans Graduate Medical Assembly
will hold its meeting March 6-9, 1961, in the head-
quarters at the Roosevelt Hotel, New Orleans. Fol-
lowing the meeting in New Orleans, the Postgrad-

uate Assembly will go on the seventeenth annual
clinical tour, involving visits to Los Angeles, Hono-
lulu, Manila, Hong Kong, Japan.

Further information may be obtained from the
Secretary of the Assembly, Dr. Mannie D. Paine,
Jr., 1430 Tulane Avenue, New Orleans 12, Louisiana.

American Medical Writers' Association

Dr. Lowell T. Coggeshall, vice president of the
University of Chicago, has been honored as re-
cipient of the 1960 Honor Award given by the
American Medical Writers' Association.

The Honor Award is given from time to time to
"non-members of the Association who have made
distinguished contributions in writing, editing, pub-
lishing, or other means of communication in medi-
cine or allied sciences."

Dr. Dean F. Smiley, of Evanston, Illinois, execu-
tive director, Education for Foreign Medical Grad-
uates, formerly editor of the Journal of Medical
Education, has been honored as recipient of the 1960
Distinguished Service Award given to a fellow of
the Writers' Association.

The Distinguished Service Award is given an-
nually to a fellow of the Association "who has
made distinguished contributions to medical litera-
ture or rendered unusual and distinguished services
to the medical profession."

OCTOBER 1, 1960

newest

J.A.M.A.

paper1

reports

"oral therapy of choice"

in management of diabetes . . . from the

mild stable adult to the severe labile juvenile

December, I960

BULLETIN BOARD

567

American Board of
Obstetrics and Gynecology

The Part 1 Examinations (written) will be held
in various cities of the United States, Canada, and
military centers outside the Continental United
States on Friday, January 13, 1961.

Reopened candidates will be required to submit
Case Reports for review 30 days after notification
of eligibility.

Scheduled Part 1 candidates are also required to
submit their 20 case abstracts in order to complete
the Part 1 Examination.

Current Bulletins outlining present requirements
may be obtained by writing to office of the Execu-
tive Secretary, Robert L. Faulkner, M.D., American
Board of Obstetrics and Gynecology, 2105 Adelbert
Road, Cleveland 6, Ohio.

STUDENT AMERICAN MEDICAL ASSOCIATION
The New Physician, second largest official med-
ical publication in the United States, received the
Honor Award for Distinguished Service in Medical
Journalism last night at the Seventeenth Annual
Meeting of the American Medical Writer's Associa-
tion held recently in Chicago. The journal is the
official publication of the Student American Medical
Association.

The award, in the category of general medical

periodicals with over 3,000 circulation reads:
"... for accuracy, clarity, conciseness and new-
ness of information; for excellence of design, print-
ing and illustrations, and for distinguished service
to the medical profession".

American College of Surgeons

Two sectional meetings included on the 1961
schedule of the American College of Surgeons will
be of interest to surgeons in this region.

The first will be held at the Dinkler-Tutwiler
Hotel in Birmingham, Alabama, January 16-18. Dr.
Arthur I. Chenowith of Birmingham is local chair-
man.

The second, a four-day sectional meeting for sur-
geons and graduate nurses, will be held in Phila-
delphia, March 6-9. Dr. Jonathan E. Rhoads of
Philadelphia is chairman of the surgeons' meeting.

All sectional meetings are under the supervision
of Dr. H. Prather Saunders, Associate Director,
American College of Surgeons. For information con-
cerning either meeting, write to Dr. William E.
Adams, Secretary, American College of Surgeons,
40 East Erie Street, Chicago 11, Illinois.

The forty-seventh annual Clinical Congress of
the College will be held October 2 through 6, 1961,
in Chicago.

results

of 104

'problem"

diabetics

treated

with...

fair to excellent control in 91 of 104 diabetics (88%)

. . . achieved with DBI use alone or combined with exogenous insulin.

"more useful and certainly more serene lives"...

In many diabetics "phenformin (DBI) has been responsible for adjusting
life situations so that patients whose livelihood was threatened, whose
peace of mind was disturbed because of lability of their diseases, have been
restored to more useful and certainly more serene lives."

"no evidence of toxicity" due to d b i . . .

a relatively low incidence of gastrointestinal

reactions. . . were found in this series.

DBI (brand.of Phenformin HCI-N»-

/i-phenethylbiguanide HCI)

is available as 25 mg. white,

scored tablets,

bottles of 100 and 1000.

1. Barclay, P. L.: J .A.M. A.
174:474. Oct. 1. 1960.

Rely on DBI, alone or with insulin, to enable a maximum number of
diabetics to enjoy continued convenience and comfort of oral therapy
in the satisfactory regulation of . . .

stable adult diabetes • sulfonylurea failures
unstable (brittle) diabetes

Detailed literature giving indications, dosage, precautions and contraindications
. . . professional samples . . . diabetes diet sheets and explanatory brochure
for patients . . . available from . . .

u. s. vitamin & pharmaceutical corporation

Arlington-Funk Laboratories, division • 250 East 43rd Street, New York 17, N. Y.

5i;s

NORTH CAROLINA MEDICAL JOURNAL

December, 1960

CONFERENCE ON
NEUROPSYCHOPHARMACOLOGY

The advancement of neuropsyehophaimacology
was the theme of a conference held in New York
City on Novembr 12 and 13. Clinical psychiatrists,
educators, researchers in basic sciences as well as
clinical investigators participated. The chairman of
the conference was Paul H. Hoch, M.D., Commis-
sioner, Department of Mental Hygiene, State of
New York, and the secretary pro tempore was
Theodore Rothman, M.D., Department of Psychia-
try, University of Southern California School of
Medicine. Evaluations of present day methods of
training investigators and testing drugs, and the
difficulties in obtaining swift dissemination of ac-
curate information to the medical profession were
critically discussed.

Among the recommendations was that a new so-
ciety be formed, with the purpose of advancing
knowledge in this important area of psychiatric re-
search.

The next meeting of the committee is scheduled
for February, 1961, and it is probable that the new
society will be organized in time for the May meet-
ing of the American Psychiatric Association.

Association of Military Surgeons

The sixty-seventh annual meeting of the Asso-
ciation of Military Surgeons of the United States,
which closed its session on November 2 with the
Honors Night Dinner, was attended by 2086 per-
sons.

New officers for 1961 are: president — Leroy E.
Burney, M.D., The Surgeon General of the U. S.
Public Health Service, Washington; first vice pres-
ident— Major General James P. Cooney, U. S. Army,
Retired; Secretary — Colonel Robert E. Bitner, U. S.
Army, Retired.

The sixty-eighth annual meeting will be held at
the Mayflower Hotel, Washington, D. C, Novem-
ber 6, 7, and 8, 1961.

INTERNATIONAL CONGRESS OF ALLERGOLOGY
The fourth International Congress of Allergology
will be held at the Hotel Commodore, New York
City, October 15-20, 1961. It is anticipated that this
will be a large and interesting meeting for all
those concerned with allergic diseases and related
fields of immunology. At the main meetings, there
will be simultaneous translations of all papers in
English, French, German, and Spanish. Prominent
physicians and scientists, from all parts of the
world, have been invited to take part in conferences,
symposiums, and panel discussions.

All physicians registering are invited to present
communications which will be grouped in various
sections according to subject matter. An active
program of entertainment is being arranged, with
several receptions, one at the Metropolitan Museum
of Art, and a banquet. For the ladies, there will be
a program of luncheons, fashion shows, and visits
to the United Nations and other points of interest.

The registration fee for regular members will be
$45.00, for wives $20.00. These fees will include the
printed proceedings and admission to the recep-
tions. The banquet will be charged separately. As
the attendance is expected to be large, it is re-
quested that persons interested obtain information
from Dr. William B. Sherman, 60 East 58th Street,
New York 22, New York.

American Nursing Association

Delegates to the American Nursing Home Asso-
ciation convention in Washington voted in favor of
a resolution that gives the green light to one of its
special committees to work out the details of a plan
for accreditation of nursing homes. A special fund
has been set aside for that purpose.

Calling for several levels of supervision, the
ANHA accreditation program would be set up on
a nation-wide basis.

The basic program, as proposed by the Accredi-
tation Committee to the convention, calls for a
grouping of nursing homes into three categories:
intensive care facility, intermediate care facility,
and supervised-living care facility.

In advocating an ANHA accreditation program,
Dr. Kocovsky made it clear that its creation does
not indicate any lack of interest in plans of the
Tripartite Committee on Accreditation, consisting
of representatives of ANHA, The American Hos-
pital Association, and American Medical Associa-
tion.

The Arthritis and
rheumatism foundation

Plans for a national conference of leaders con-
cerned with the health menace of arthritis quackery
have been announced by Floyd B. Odium, national
chairman of The Arthritis and Rheumatism Foun-
dation. The conference will be held early in March,
1961, in Washington, D. C, according to the an-
nouncement made at the voluntary health organ-
ization's twelfth annual meeting at the Hotel Com-
modore in New York.

World Medical Association

Dr. Heinz Lord, a practicing surgeon of Barnes-
ville, Ohio has been elected by the General Assem-
bly to succeed Dr. Louis H. Bauer of New York
City as Secretary General of The World Medical
Association.

Dr. Lord, a Peruvian citizen by bh'th, although
actually born and received his preliminary educa-
tion in Germany, will become Secretary General of
The World Medical Association on January 1, 1961.

The retiring Secretary General, Dr. Louis H.
Bauer was appointed to that position in 1948. On
January 1, 1961 he will become Consultant to The
World Medical Association.

December, 1960

BULLETIN BOARD

569

Institute of Industrial Health

The University of Cincinnati's Institute of In-
dustrial Health is offering graduate fellowships in
Industrial Medicine. The Institute, which is in the
College of Medicine, provides professional training
for graduates of approved medical schools who have
completed at least one year of internship.

The three-year program leading to the degree of
Doctor of Industrial Medicine satisfies the require-
ments for certification in Occupational Medicine by
the American Board of Preventive Medicine.

Requests for additional information should be
addressed to The Secretary, Institute of Industrial
Health, College of Medicine, Eden and Bethesda
Avenues, Cincinnati 19, Ohio.

Air Research and Development Command

Brigadier General Benjamin A. Strickland, Jr..
who has served as surgeon of a horse-drawn field
artillery regiment and on the Bernard Baruch Com-
mittee on Physical Medicine and Rehabilitation, has
been assigned to Headquarters, Air Research and
Development Command (ARDC), Washington, D.
C.

General Strickland recently became ARDC's
Deputy Assistant for Bioastronautics. Previously he
held the dual assignment of command surgeon of
Continental Air Defense Command and Air Defense
Command at Colorado Springs, Colorado.

Dr. Strickland was born in Whitakers, North
Carolina and received his medical degree from Duke
University School of Medicine in 1933. Two years
later he entered military service and embarked on
a distinguished career in military medicine.

Because of his extensive background in Physical
Medicine and Rehabilitation General Strickland was
chosen by the Army Surgeon General in 1943 to
serve on the Bernard Baruch Committee on Physical
Medicine and Rehabilitation. He worked with Mr.
Baruch from 1943 to 1945 on rehabilitation of
World War II sick and wounded.

In 1947 while assigned in the Army Surgeon
General's office as Chief of Physical Medicine Con-
sultants Division, General Strickland was elected to
the position of Vice Chairman of the American
Board of Physical Medicine and Rehabilitation.

A year later he was assigned to the USAF School
of Aviation Medicine, Randolph AFB, Texas, where
he did extensive research in air sickness and in air
evacuation of the sick and injured. His assignments
at the School of Aviation Medicine included the
position of Director of Military Medicine and later
Chief of the Department of Internal Medicine.

General Strickland did the initial planning and
organization of the Gunter Branch of the School of
Aviation Medicine and served as Commandant of
this School from 1 August 1951 to 1 October 1953.

Rated as a Chief Flight Surgeon, Dr. Strickland
is certified in aviation medicine and in physical
medicine and rehabilitation. He is the author and/or
co-author of 31 medical and scientific publications
on various aspects of aviation medicine, and physi-
cal medicine and rehabilitation.

U. S. Department of
Health, Education, and Welfare

Responsibility for planning and operating the
Nation's emergency medical stockpile program has
been assumed by the Public Health Service, it was
announced recently by the Office of Civil and De-
fense Mobilization and the Department of Health,
Education, and Welfare.

This plan, part of the National Plan for Civil
Defense and Defense Mobilization, aims at develop-
ing an organization and procedures for managing
medical facilities, personnel and resources for na-
tional emergencies.

The transfer of authority involves about $200
million worth of medical supplies and equipment
'ocated in 33 warehouses throughout the country.
Included in the stockpile are 1,932 "packaged" 200-
ted hosniti's for civil defense emergency use, valued
at $20,000 each. About 1,500 of these are now stored
nt strategic locations across the country and others
are in use for demonstration purposes and for train-
ing personnel.

Stockpiling responsibilities of the Public Health
Service, under OCDM policy control, will include
procurement, maintenance, storage, inspection,
quality control, distribution, utilization and prop-
erty accountability of essential survival supplies
and equipment.

Hospital Food Costs

The cost of preparing patient meals in the na-
tion's hospitals averages $3.64 per patient day,
according to a report in The Modern Hospital
magazine.

The professional journal said the cost of feeding
patients is one of the largest hospital operating
expenses.

Nationally the cost per patient day ranges from
a low of $2.11 in city, county and state hospitals in
the south and southwest to $5.88 per patient day in
hospitals of 250-or-more beds in the western states.

Classified Advertisement

WANTED: Intern or resident doctor with North
Carolina license to relieve me for vacation from
January 23 through February 1st. General prac-
tice without obstetrical deliveries. You may use
my car, my house, hospital facilities and con-
sultants. State salary expected. Please contact
me at once. Samuel H. Justa, M.D., 513 Sunset
Avenue, Rocky Mount, N. C.

FOR SALE: Burdick EK-2 Electrocardiograph
machine. Burdick Ultra-violet lamp. McKesson
Basal Metabolism machine. Continental X-Ray
and Fluoroscope combination machine, together
with all the necessary accessories. Continental
Diathermy machine. All of the above are in per-
fect working order. If interested, contact: Dr.
A. L. Feuer, 411 South Marietta Street Gastonia,
North Carolina.

570

NORTH CAROLINA MEDICAL JOURNAL

December, 19(50

BOOK REVIEWS

Human Pituitary Hormones. Vol. 13, Ciba
Foundation Colloquia on Endocrinology.
Edited by G. E. W. Wolstenholme and Ce-
cilia M. O'Connor. 321 pages. Price $9.50.
Boston: Little, Brown and Company, 1960.
Not too many years ago at that circus without
tents called endocrinology, the pituitary problem
was a sideshow peopled by immature giants and
grotesque wrestlers, bearded ladies, and Tom
Thumbs. To reduce such chaos to understanding
demands a master hand; fortunately it was avail-
able in the person of Professor B. A. Houssay. It is
particularly fitting that this colloquium was held in
Buenos Aires in his honor; that it could be held
there is no small tribute to his own undeviating
courage in opposing the shallow authoritarianism
and shabby opportunism of the Peron regimen with
his own scrupulous regard for freedom of inquiry
and the universality of knowledge.

What Houssay found in the sideshow has now
taken over one full ring of the circus, which is now
more active than all three once were. Such an ad-
vance is the reason for this colloquium. The rapid-
ly expanding knowledge of the chemistry of an-
terior pituitary secretion is summarized in excel-
lent reviews by Wilhelmi, Li, Genzell, Lee and Ler-
ner, and Ieuan Harris. The many facets of growth
hormone activity are considered by Raben, Luft
and Beck, and by Russell Fraser, who propounds
the most surprising views of the session in his dis-
cussion of the effects of growth hormones on para-
thyroid homeostasis. Other presentations include
evaluations of pituitary gonadotrophin ass.iy and
of thyrotrophic hormone in blood. In fact the only
unexpected omission is the lack of spirited dis-
cussion of means of assaying exophthalmos-produe-
ing hormone by injecting appropriate materials in-
to various species of goldfish. There is even a stim-
ulating discussion about terminology, without which
no such session is truly complete — just as typical-
ly the language must continue to be too inexact to
satisfy all participants.

For the initiated such a session must be stimu-
lating; for the would-be initiate, confusing but en-
couraging; and for the rest of us, prodigious and
provocative.

Congenital Malformations. Edited by G. E.

W. Wolstenholme and C. M. O'Connor. 308

pages. Price, $9.00. Boston: Little, Brown

and Company, 1960.
This volume records the proceedings of a gen-
eral symposium devoted to congenital malforma-
tions sponsored by the Ciba Foundation. It is com-
prised of 12 papers (chapters) and the discussion
which followed each. The last chapter presents a
general discussion of the problem. The chapters
range in character from those presenting a general
account of the role of genetic or environmntal fac-
tors in the particular etiology of congenital mal-

formations to those reporting on the ell'ects of
particular teratogenic agents.

As is frequently the case in "non-books," it is
difficult to evaluate a volume in which the chap-
ters vary so widely in nature and quality. The pa-
pers by McKeown and Record on ;i five-year epi-
demiologic study of congenital malformations ami
by McLaren and Michie on congenital runts de-
scribed well designed studies. The several papers
on particular teratogenic agents point up the ne-
cessity for caution in the use of certain antimeta-
bolites and anti-biotics in the pregnant patient.
Tuchmann-Duplessis and Mercier-Parot, for in-
stance, described experiments in rats which demon-
strated that Actinomycin D is a most potent tera-
togen in the rat at dosage levels significantly
lower than those being employee! in human patients.
These experiments are being extended to the rab-
bit, and preliminary results indicate that rabbit
embryos are also adversely affected.

In spite of the fact that most of the material
presented is available elsewhere, there is doubtless
value in bringing together embryologists, epidemi-
ologists, geneticists, and clinical research workers
and in presenting samples of their work in a single
volume. Obstetricians and pediatricians will be es-
pecially interested in learning of the present di-
rections, perspectives, and limitations of current
research on congenital malformations.

The Role of the Physician in Environmental
Pediatrics. By Carl C. Fischer, M.D. 122
pages. New York: Landsberger Medical
Books, Inc., 1960.

This short, well written book discusses the prob-
lems other than bodily disease about which the
modern pediatrician must have knowledge.

Dr. Fischer discusses accidents, adoption, school
health, handicaps, and adolescence in 150 pages. Ob-
viously, he has spent few words on generalizations
and has given his evidence, stated his views on the
problems, and made his suggestions in a concise
manner.

The physician's role in accident-prevention is pri-
marily educational. In adoptions, he should inform
himself of the local laws and procedures and be-
come able to counsel intelligently with families
seeking adopted children. Furthermore, if the local
laws and practices are not standardized nor satis-
factory, it is incumbent upon him to do what he
can to improve or change them. He should find out
what the local school health program is and do his
utmost to improve it through personal, active par-
ticipation, and by means of advice to those con-
cerned with its administration.

Dr. Fischer covers handicaps in an holistic man-
ner, from cosmetic to social handicaps, discussing
cause, control and cure where these are known, and
the proper handling of all types of handicaps. He
suggests that an adequate community program for
handicapped children would encompass: Enumera-

December, 1960

BOOK REVIEWS

571

tion, Evaluation, Education, Irradication, and Eman-
cipation.

The chapter on adolescence is a monograph in
miniature, and intelligently covers all the param-
eters of this period of life. His section on juvenile
: delinquency is exceptionally well thought through.

This small volume is recommended to pediatri-
cians and to all physicians who care for children
and adolescents. It does not answer a great many
questions regarding therapy, but it emphasizes
problems that have long been overlooked by many
physicians.

The Development of the Infant and Young
Child: Normal and Abnormal. By R. S

Illingworth, M.D. 318 pages. Price, $6.50.
Edinburgh and London: E. & S. Living-
stone, Lmt., The Williams & Wilkins Com-
pany, Baltimore, exclusive U. S. agents,
I960.
It is recognized that a knowledge of child devel-
opment and its variations is necessary for anyone
responsible for the management of infants and chil-
dren. In spite of this, few of the books dealing
with development are both factually correct and at
: the same time interesting. Dr. Illingworth has ac-
complished both of these aims in this book. He has
critically discussed many areas in development and
\ documented these discussions with an excellent bib-
1 liography. Because much of the work in develop-
ment is not mathematically accurate, much of the
material must remain a matter of opinion. This
reviewer feels that Dr. Illingworth has presented
his opinions in a logical and reasonable manner.

Certain chapters are of unusual interest. The
■ chapter on the predictive value of development as-
sessment is superior. His discussion of the prenatal
I and perinatal factors governing subsequent devel-
opment is up-to-date. The chapter on the associa-
tion of physical defects with diseases of mental de-
velopment forms a good reference for anyone who
lis concerned with syndromes involving mental re-
tardation. His discussion of normal development is

a good review but adds little new information in
this field. The chapter entitled "Variations in In-
dividual Fields of Development" emphasizes well
the fact that children should be considered as indi-
viduals. The final chapter, on the mistakes and
difficulties in developmental diagnosis, is a)i ex-
tremely clear discussion of the possible errors one
can make in interpreting the developmental status
of the infant or child.

This reviewer feels that this book is the most
adequate single source of information concerning
the field of development that he has read. It is be-
lieved that the facts are correct and that the inter-
pretations are reasonable. Equally important, the
book i : written in a manner to hold the reader's
interest. It can be strongly recommended for any-
body involved in the management of infants and
children. Obviously, this factor is of particular in-
tere t to pediatricians, psychologists, and the
various personnel involved in mental evaluation.

Much of the material would be of value to people
who counsel parents concerning future pregnancies.
For this reason, obstetricians and general practi-
tioners would find this book of great value.

Sight, A Handbook for Laymen. By Roy O.

Scholz, M.D. 166 pages. Price, $3.50. Gar-
den City, New York: Doubleday and Com-
pany, Inc., 1960

Sight, A Handbook for Laymen adequately covers
an admittedly difficult subject for the most fickle
audience, the general public. Dr. Scholz displays
great talent in maintaining the precarious but
necessary balance between over-simplification on the
one hand, excessive detail on the other. This inform-
ative little book is full of practical information,
particularly for any patient who has an eye prob-
lem. The chapter on the cataract is especially
helpful for the patient with this disorder. Excellent
chapters on contact lenses, glasses, glaucoma, and
childhood eye problems are included. The routine

•••

a Greensboro
•• •• • .

I. So Raleigh '

• •* ....

• Washington^

A

:••

(^

MATERNAL DEATHS REPORTED IN NORTH CAROLINA^
SINCE JANUARY I, I960

Wilmington,^

Each dot represents one death

I

572

NORTH CAROLINA MEDICAL JOURNAL

December, 1960

eye exmination is described and the value of eye
exercises is questioned.

The chief criticism occurring to the medical
reader is the inevitable errors which seem to crop
up on a book of this sort. In spite of this drawback,
the volume is a refreshing respite from the wild
"medical" claims and exaggerations constantly en-
countered in the lay press. For patients with ocular
problems, this book is recommended reading.

Arthritis and Rheumatism Foundation
Issues Report

The Arthritis and Rheumatism Foundation has
announced the publication of a report entitled The
Misrepresentation of Arthritis Drugs and Devices in
in the United States. The 166-page book is an offi-
cial documentation of the Foundation's claim that
the nation's 11,000,000 arthritis victims are being
cheated of more than $250,000,000 yearly on mis-
represented products and phony "cures."

The report presents for the first time a compre-
hensive review of misrepresented arthritis products
and their promotion. It also discusses government
legislation pertinent to the problem.

The study which resulted in publication of the
report was undertaken as part of the Foundation's
program to alert the public to the dangers of in-
dulging in misrepresented or worthless treatments
while postponing effective medical care.

Copies of The Misrepresentation of Arthritis
Drugs and Devices in the United States are avail-
able from The Arthritis and Rheumatism Founda-
tion, 10 Columbus Circle, New York 19, New York.
The price is $3.50 per copy.

iln ilrtnnriam

John Haywood Stanley, M.D.

Whereas in the Province of God, Dr. J. H.
Stanley of Four Oaks, North Carolina, our brother
and fellow member of the Johnston County Medical
Society, has fallen asleep and passed on to give an
account of his work among us, therefore be it

Resolved that it is the desire of his fellow mem-
bers to give an expression of their love, respect and
admiration for our departed brother. We recognize
in him a man of worth and a friend of all ; a
doctor believed and trusted in a special manner by
his people, having served them for the unusual
period of more than 50 years; a good attendant
upon the meetings of this county medical society,
and an honorary member of the Medical Society of
the State of North Carolina; modest and reserved
in his demeanor and a lover of his profession.

Be it further resolved that our sympathy goes
out to his family and his patients, and that a page
in our County Society records be ascribed to his
memory.

E. H. Alderman, M.D.

President

C. Watson Wharton, M.D.

Secretary

Christopher Sylvanus Barker, M.D.

Dr. Christopher Sylvanus Barker was born Oc-
tober 28, 1885, in Jones County, North Carolina. He
graduated from Trenton High School and Rhodes
Military Institute in Kinston. He attended the Uni-
versity of North Carolina for three years and re-
ceived his medical degree from the Jefferson Med-
ical College in 1909. He then interned in the South
Bethlehem Hospital in Pennsylvania and returned
to Trenton, North Carolina, whera he practiced
medicine. After seven years of practice there he
moved to New Bern in 1917, where he continued
the general practice of medicine until his recent
retirement.

Dr. Chris served his community well and faith-
fully from horse and buggy days to our mine mod-
ern times. He was kind and considerate of hi-; pa-
tients and very obliging with his fellow practitioners.
Needless to say, he was successful in his practice
of medicine and in his community life. He was a
member of the Centenary Methodist Church, Crav-
en County Medical Society and an honorary member
of North Carolina Medical Society, which awarded
him a certificate of membership in the Fifty Yea"
Club. He was also a member of the American .Med-
ical Association. He was on the Staff of St. Luke's
Hospital and Good Shepherd Hospital in New Bern.
He was a member of the Zion Masonic Lodge of
Trenton, North Carolina; New Bern Chapter 1G, St.
John's Commandery 10, the Sudan Shrine Temple,
and the Benevolent and Protective Order of Elks.
He served as a director of First Federal Savings
and Loan Association in New Bern.

Dr. Barker died at his home in New Bern on
October 11, 1960, at the age of 74 following an ill-
ness of several years. He is survived by his wife,
Mrs. Ruth Henderson Barker; two sons, Rear Ad-
miral C. S. Barker, Jr. and Dr. Charles T. Barker,
a practicing dentist in New Bern, and a host of
friends and former patients wdio will feel his ab-
sence greatly.

The Month in Washington

Election of Senator John F. Kennedy as
President made it probable that the issue
of providing health care for the aged under
Social Security again will be raised in Con-
gress next year.

Kennedy will go into the White House
pledged "to the immediate enactment of a
program of medical care for the aged
through Social Security." His intentions
present a serious challenge to the nation's
physicians who have vigorously opposed use
of the Social Security system to provide
health care for the aged.

Kennedy's program would provide what
he described as "a life policy of paid-up
(Continued on page 580)

December, 1960

ADVERTISEMENTS

XXXIII

A NEW THERAPEUTIC ENTITY FOR DIARRHEA

LOMOTIL

SELECTIVELY LOWERS PROPULSIVE MOTILITY

LOMOTIL represents a major advance over the
opium derivatives in controlling the propulsive
hypermotility occurring in diarrhea.

Precise quantitative pharmacologic studies dem-
onstrate that Lomotil controls intestinal propulsion
in approximately Hi the dosage of morphine and
'4o the dosage of atropine and that therapeutic
doses of Lomotil produce few or none of the diffuse
untoward effects of these agents.

Clinical experience in 1 ,3 1 4 patients amply sup-
ports these findings. Even in such a severe test of
antidiarrheal effectiveness as the colonic hyperac-
tivity in patients with colectomy, Lomotil is effec-
tive in significantly slowing the fecal stream.

Whenever a paregoric-like action is indicated,
Lomotil now offers positive antidiarrheal control
. . . with safety and greater convenience. In addition,

LOW DOSAGE EFFECTIVENESS
OF LOMOTIL

ed;-,i, in mg. per kg. of body weight in mice

1

■ 9.0

LOMOTIL

MORPHINE

ATROPINE

EFFICACY AND SAFETY of Lomotil arc indicated by lis low median effective
dose. As measured by inhibition of charcoal ptopulsion in mice. Lomotil was
effective in about \\i the dosage of motphine hydrochloride and in about Vjo the
dosage of atropine sulfate

as a nonrefillable prescription product, Lomotil
offers the physician full control of his patients'
medication.

PRECAUTION: While it is necessary to classify
Lomotil as a narcotic, no instance of addiction has
been encountered in patients taking therapeutic
doses. The abuse liability of Lomotil is comparable
with that of codeine. Patients have taken therapeu-
tic doses of Lomotil daily for as long as 300 days
without showing withdrawal symptoms, even when
challenged with nalorphine.

Recommended dosages should not be exceeded.

DOSAGE: The recommended initial dosage for
adults is two tablets (5 mg.) three or four times
daily, reduced to meet the requirements of each
patient as soon as the diarrhea is controlled. Main-
tenance dosage may be as low as two tablets daily.
Lomotil, brand of diphenoxylate hydrochloride
with atropine sulfate, is supplied as unscored, un-
coated white tablets of 2.5 mg., each containing
0.025 mg. (^.jon gr.) of atropine sulfate to dis-
courage deliberate overdosage.

Subject to Federal Narcotic Law.

Descriptive literature and directions for use available
in Physicians' New Product Brochure No. 81 from

G.D. SEARLEaco.

P.O. Box 5110, Chicago 80, Illinois
Research in the Service of Medicine

XXXIV

NORTH CAROLINA MEDICAL JOURNAL

December, 1960

ALL OVER AMERICA!

KENTwiththe MICRONITE FILTER

IS SMOKED BY
MORE SCIENTISTS and EDUCATORS

than any other cigarette!*

FIVE

TOP

BRANDS

OF

CIGARETTES

SMOKED

BT AMERICAN

SCIENTISTS

KENT.

15.3%

BRAND "A" 1
BRAND "G i

10.5%
7.9%

BRAND F i

7.8%

BRAND ~B i

7.3%

FIVE TOP BRANOS OF CIGARETTES
SMOKED BY AMERICAN EDUCATORS

KENT.

BRAND ~G a
BRAND -E c
BRAND A E
BRAND "F" ■

7 7%
7.7%

This does not constitute a
professional endorsement
of Kent. But these men, like
millions of other Kent smokers,
smoke for pleasure, and choose
their cigarette accordingly.

If you would like the booklet, "The Story of Kent", for your
own use, write to: P. Lorillard Company — Research De-
partment, 200 East 42nd Street, New York 17, New York.

The rich pleasure of smoking
Kent comes from the flavor
of the world's finest natural
tobaccos, and the free and
easy draw of Kent's famous
Micronite Filter.

For good smoking taste, IFIMflillF

it makes good sense to smoke MM BalT

if. RMulti of a coniimjing »tuo> of cigarette [net* fences, conducted by OB'ien Sneoood Allocates. NT.NT
A PRODUCT OF P LORILLARD COMPANY FIRST WITH THE FINEST CIGARETTES THROUGH LORILLARD RESEARCH

O '*<.!.' -jCoAioQ

December, 1960

ADVERTISEMENTS

XXXV

• increases bile
Dechotyl stimulates
the flow of bile —
a natural bowel
regulator

» improves motility

Dechotyl gently stimulates

intestinal peristalsis

• softens feces
""" Dechotyl expedites fluid
penetration into bowel contents

helps free your patient from both...
constipation and laxatives

DECHOTYL

TR ABLETS*

well tolerated... gentle transition to normal bowel function

Recommended to help convert the patient — naturally and gradually — to healthy
bowel habits. Regimens of one week or more are suggested to assure mainte-
nance of normal rhythm and to avoid the repetition of either laxative abuse or
constipation.

Average adult dose: Two Trablets at bedtime as needed or as directed by a physician.
Action usually is gradual, and some patients may need I or 2 Trablets 3 or 4 times daily.

Contraindications: Biliary tract obstruction; acute hepatitis.

Dechotyl Trablets provide 200 mg. Decholin,® (dehydrocholic acid, Ames), 50 mg.
desoxycholic acid, and 50 mg. dioctyl sodium sulfosuccinate, in each trapezoid-shaped,
yellow Trablet. Bottles of 100.

•Ames t.m. for trapezoid-shaped tablet. e«is°

AMES

COMPANY, INC
Elkhart . Indiana

fA"

XXXVI

NORTH CAROLINA MEDICAL JOURNAL

December, 1960

IN GOLDS AND SINUSITIS-

THE RIGHT AMOUNT OF "INNER SPACE

RIGHT AWAY

1l)"(t,"ut K

LABORATORIES
ew York 18, N. Y.

NEO-SYNEPHRINE

(Brand of phenylephrine hydrochloride)

hydrochloride

NASAL SOLUTIONS AND SPRAYS

Neo-Synephrine hydrochloride relieves the boggy
feeling of colds immediately and safely, without
causing systemic toxicity or chemical harm to nasal
membranes. Turbinates shrink, sinus ostia open,
ventilation and drainage resume, and mouth-breath-
ing is no longer necessary.

Gentle Neo-Synephrine shrinks nasal membranes
for from two to three hours without stinging or
harming delicate respiratory tissues. Post-thera-
peutic turgescence is minimal. Neo-Synephrine does
not lose its effectiveness with repeated applications
nor does it cause central nervous stimulation, jitters,
insomnia or tachycardia.

Neo-Synephrine solutions and sprays produce shrink-
age of tissue without interfering with ciliary activity
or the protective mucous blanket.

For wide latitude of effective and safe treatment,
Neo-Synephrine hydrochloride is available in nasal
sprays for adults and children; in solutions from
ys% t0 1%> and in aromatic solution and water
soluble jelly.

December, 1960

ADVERTISEMENTS

XXXVII

for chronic bronchitis

capsules

The Original Tetracycline Phosphate Compl

0. ;,791,G03

effective control of pathogens... with an unsurpassed record of safety and tolerance

BRISTOL LABORATORIES, SYRACUSE, new YORK (j BRISTOL;
Div. of Bristol-Myers Co.

SUPPLY: TETREX Capsules — tetracycline phosphate
complex-each equivalent to 250 mg. tetracycline HCI
activity. Bottles of 16 and 100.

TETREX Syrup -tetracycline (ammonium polyphosphate
buffered) syrup -equivalent to 125 mg. tetracyclino HCI
activity per 5 ml.teaspoonful. Bottles of 2 fl. oz. and 1 pint.

XXXVIII NORTH CAROLINA MEDICAL JOURNAL December 1960

Major Hospital Policy

Pays up to $10,000.00 for each member of your family,
subject to deductible you choose

Deductible Plans available:
$100.00
$300.00
$500.00

Business Expense Policy

Covers your office overhead while you
are disabled, up to $1,000.00 per month

approved by

The Medical Society of North Carolina
for Its Members

Write or Call
for information

Ralph J* Golden Insurance Agency

Ralph J. Golden Associates Henry Maclin, IV

Harry L. Smith John Carson

108 East North wood Street

Across Street from Cone Hospital

GREENSBORO, N. C.

Phones: BRoadway 5-3400 BRoadway 5-5035

I

December, 1960

ADVERTISEMENTS

XXXIX

Recognizing that the exchange of ideas is fundamental to medical progress, Lederle
continues its Symposium program with the 10th year of scheduled meetings. Through
these Symposia, sponsored by medical organizations with our cooperation, over 50,000
physicians have had the opportunity to hear and question authorities on important
advances in clinical medicine and surgery. You have a standing invitation to attend any
Of these Symposia with your wife, for whom a special program is planned.

ANOTHER YEAR OF SYMPOSIA . . .

PORTLAND, OREGON

Wednesday, January 11, 1961
The Sheraton-Portland Hotel

MONTGOMERY, ALABAMA
Friday, January 13, 1961
The Whitley Hotel

MINNEAPOLIS, MINNESOTA

Monday, January 16, 1961
The Hotel Leamington

LEMONT, ILLINOIS

Wednesday, January 18, 1961
The White Fence Farm

CINCINNATI, OHIO

Sunday, January 22, 1961
The Netherland Hilton Hotel

NEW DORP, STATEN IS., N. Y.

Wednesday, February 15, 1961
The Tavern-on-the-Green

CHARLESTON, SOUTH CAROLINA

Thursday, February 23, 1961
The Francis-Marion Hotel

ANCHORAGE, ALASKA

Saturday, February 25, 1961
The Westward Hotel

BAKERSFIELD, CALIFORNIA

Friday, March 3, 1961
The Bakersfield Hacienda

WILLIAMSBURG, VIRGINIA

Wednesday, March 8, 1961
The Williamsburg Lodge

ALBUQUERQUE, NEW MEXICO

Saturday, March 11, 1961
The Hilton Hotel

OMAHA, NEBRASKA

Thursday, March 16, 1961
The Sheraton-Fontenelle Hotel

PHOENIX, ARIZONA

Saturday, March 18, 1961
The Westward Ho Hotel

LOUISVILLE, KENTUCKY

Thursday, March 23, 1961
The Sheraton-Seelbach Hotel

BAY SHORE, LONG ISLAND,
NEW YORK

Wednesday, April 12, 1961
The LaGrange Inn

BUTTE, MONTANA

Saturday, April 22, 1961
The Finlen Hotel

ITHACA, NEW YORK

Thursday, April 27, 1961
The Statler Club

ERIE, PENNSYLVANIA

Wednesday, May 3, 1961
The Hotel Lawrence

SACRAMENTO, CALIFORNIA

Wednesday, May 10, 1961
The El Dorado Hotel

LOS ANGELES, CALIFORNIA

Wednesday, June 7, 1961
The Statler Hotel

LEDERLE LABORATORIES, a Division of AMERICAN CYANAMID COMPANY, Pearl River, N. Y.

XL

NORTH CAROLINA MEDICAL JOURNAL

December, I960

NaClex

benzthia/idc

a new diuretic
with an
unsurpassed
faculty for
salt excretion

as salt goes, so goes edema

A basic principle of diuresis is that "increased urine
volume and loss of body weight are proportional to
and the osmotic consequences of loss of ions."'

Robins' new NaClex is a potent, oral, non-mercurial
diuretic that helps reduce edema through the appli-
cation of this fundamental principle. It limits the
reabsorption of sodium and chloride in the renal
proximal tubules (with a relative sparing of potassium).
The body's homeostatic mechanism responds by in-
creasing the excretion of excess extracellular water.
Thus the NaClex-induccd removal of salt leads to a
reduction of edema.

a unique chemical structure

NaClex (benzthiazidc) is a new molecule which pro-
vides a "pronounced increase in diuretic potency"2
over its antecedent sullonamide compound. Com-
pared tablet for tablet with current oral diuretics, it
is unsurpassed in diuretic potency.

twofold value

NaClex produces diuresis, weight loss, and sympto-
matic improvement in edema associated with various
conditions. It also has antihypertensive properties
and may be used alone in mild hypertension or with
other antihypertensive drugs in severer cases.

For complete dosage schedules, precautions, or other informa-
tion about .XaClex, please consult basic literature, package
insert, or your local Robins representative, or write to the
A. H Robins Co., Inc.

Supply: Yellow, scored 50 mg. tablets.

References: I. Pius, R F., Am. J. Med., 24:745, 1958. 2. Ford,
R. V., Cur. Thcrap. Res., 2:51, I960.

A. H. ROBINS COxMPANY, INC.
RICHMOND 20, VIRGINIA

December, 1960

ADVERTISEMENTS

XLI

Rautrax-N lowers high blood pressure gently,
gradually . . . protects against sharp fluctuations
in the normal pressure swing. Rautrax-N com-
bines Raudixin, the cornerstone of antihyperten-
sive therapy, with Naturetin, the new, safer
diuretic-antihypertensive agent. The comple-
mentary action of the components permits a
lower dose of each thus reducing the incidence
of side effects. The result: Maximum effective-
ness, minimal dosage, enhanced safety. Rautrax-N
also contains potassium chloride — for added
protection against possible potassium depletion
during maintenance therapy.

Supply: Rautrax-N — capsule-shaped tablets —
50 mg. Raudixin, 4 mg. Naturetin, and 400 mg.
potassium chloride. Rautrax-N Modified — cap-
sule-shaped tablets — 50 mg. Raudixin, 2 mg.
Naturetin, and 400 mg. potassium chloride. For
complete information write Squibb, 745 Fifth
Avenue, New York 22, N. Y.

Rautrax-N

Squibb Standardized Whole Root Rauwolfia Serpentina (Raudixin)

and Benzydroflumethiaiide (*Naturetin) with Potassium Chloride SQJJIBB-

XLII

NORTH CAROLINA MEDICAL JOURNAL

December, 1960

minimize care and eliminate despair with

METHEDRINE

brand Methamphetamine Hydrochloride

Controls food craving, keeps the reaucer happy— In obesity, "our drug of choice has
been methedrine . . . because it produces the same central effect with about one-
half the dose required with plain amphetamine, because the effect is more pro-
longed, and because undesirable peripheral effects are significantly minimized
or entirely absent."1 Literature available on request.
Supplied: Tablets 5 mg., scored. Bottles of 100 and 1000.

' Douglas, H. S.: West. J. Surg. 59:238 (May) 1951.

®

'35

J£i BURROUGHS WELLCOME & CO. (U. S. A.) INC.. Tuckahoe. New York

December, 1960

ADVERTISEMENTS

XLIII

How to be
Carefree
Without
Hardly
Trying • • •

It really takes a load off your mind. . .
to know that you are protected from
loss of income due to illness or accident'

"Dr. Carefree" has no 30-day
sick leave ... no Workmen's
Compensation . . . BUT he has a
modern emergency INCOME PROTEC-
TION PLAN with Mutual of Omaha.

When he is totally disabled by accident or sickness covered by this plan, this plan
will give him emergency income, free of Federal income tax, eliminating the night-
mare caused by a long disability.

Thousands of members of the Medical Profession are protected with Mutual of Oma-
ha's PROFESSIONAL MEN'S PLAN, especially designed to meet the needs of the
profession.

If you do not already own a Mutual of Omaha INCOME PROTECTION PLAN, get in
touch now with the nearest General Agent, listed below. You'll get full details, with-
out obligation.

Mutuah

OF OMAH

Largest Exclusive Health and Accident Company in the World.

G. A. RICHARDSON, General Agent
Winston-Salem, N. C.

J. A. MORAN, General Agent
Wilmington, N. C.

J. P. GILES, General Agent
Asheville, N. C.

XLIV

NORTH CAROLINA MEDICAL JOURNAL

December, 1960

* . •S-.-W^it- _».,.

new clinical study1
cites beneficial -
results in over
90% of cases in

Use of SARDO in 118 dermatological patients to relieve
dry, itchy, scaly, fissured skfn achieved these excellent
results:

CASES AFTER SARDO*

Excellent Good Poor

49 Senile skin 32 13 4
26 Dry Skin in younger

patients (diabetes, etc.) 14 11 1

20 Atopic dermatitis 8 10 2

13 Actinic changes 9 4 -

10 Ichthyosis 3 4 3

Skin Conditions Benefited No Benefit

20 Nummular dermatitis 19 1

10 Neurodermatitis 10 —

11

1

i

m

SARDO acts12 to (A) lubricate and soften skin, (B) replenish natural
emollient oil, (C) prevent excessive evaporation of essential moisture.

SARDO releases millions of microfine water-miscible globules to pro-
vide a soothing suspension which enhances the efficacy of your other
therapy.

SARDO is pleasant, convenient, easy to use; non-sticky, non-sensitiz-
ing. Bottles of 4, 8 and 16 oz.

for SAMPLES and complete reprint of Weissberg paper, please write . . .

SCLVdeCLUy InC. 75 East 55th Street, New York 22, N. Y.

1. Weissberg, G.:
Clin. Med., June
1960.

2. Spoor, H. J.:
N. Y. St. J. Med.,
Oct. 15, 1958.

^patent pending
T.M. ©I960

December, 1960

ADVERTISEMENTS

XLV

*SSSi

1 r 11 p

I i

«s> as «s

1&

w bi

Ifl

SSSS^Ss

%i

i 15 1 €1 p J

prednisolone

TM

%#lilw

I

ss#

Hasntetiartce Ifese

■ Better therapeutic response

■ Reduced daily dosage

■ Fewer side effects

■ Greater safety, convenience
and economy

Now, for the first time,
the benefits of steroid therapy
are enhanced by sustained release
PREDLON PELSULES.

USES: Rheumatoid arthritis,
disseminated lupus erythematosus,
allergic diseases, and
other conditions where the
use of steroids is indicated.

SUPPLY: PREDLON 5 mg.
is available in bottles
of30andl00Pelsules.

DRUG^

.^.... ........ ...... ............ .,„...., y.^

fry/"""/. '''<'"/>'//''<'#/'////■ '"/4

9

-?«^ -

i

if

A

Samples and Literature on request

WINSTON-SALEM 1, NORTH CAROLINA

'trademark for timed disintegration capsules

XLVI

NORTH CAROLINA MEDICAL JOURNAL

December, 19(30

December, 1960

ADVERTISEMENTS

XLVII

Income for th

e members o

f the

North Carolina Medical Profession

Pays From The First Day of Medical Attention Dur-
ing Total Disability and Total Loss of Time Because
of SICKNESS or ACCIDENT Originating After the
Effective Dates of Coverages and For As Long As
Total Disability, Total Loss of Time and Regular Medical Attention Continue

NOT FOR ONLY 26 WEEKS — NOT FOR ONLY 52 WEEKS
BUT EVEN FOR YOUR ENTIRE LIFETIME!

House Confinement not required at any time.

Accidental loss of hands, feet or eyesight pays monthly benefits —

not just a lump sum.

EXTRA BENEFITS — Double monthly benefits while you are hospi-
talized payable for as long as three months.
Cash benefits for accidental death.

Double income benefits if disabled in specified travel accident
named in the policy.

OTHER IMPORTANT FEATURES — Waiver of Premium Provision.
Limited Commercial Air Line Passenger Coverage. No Automatic
Termination Age During Policy Period. A Special Renewal Agree-
ment.

EFFECTIVE DATES OF COVERAGES — EXCEPTIONS

This policy covers accidents from Noon of the Policy date and sickness originating more
than thirty days after the Policy Date, unless specifically excluded — except — the policy
does not cover, and the premium includes no charge for loss which is caused by: war or any
act of war or while in military service of any country at war; suicide or attempted suicide;
insanity or mental derangement; travel outside the United States, Alaska or Canada (un-
less otherwise extended by rider) and aeronautics or air travel other than limited commer-
cial air line passenger travel.

(MP 3208)

................. -» - _ . UNITED

„ UNITED INSURANCE COMPANY OF AMERICA, I lueiimkirr

Lifetime Disability Income Dept. I

1 301 East Boulevard, Charlotte 3, North Carolina. COMPANY

t I

I would like more information about your I Qp AMERICA
1 lifetime disability income protection.

I '

I understand I will not be obligated. , Home office: Chicago 5, Illinois

■ Name Age '

Address fju Mail coupon today while

• or attached letterhead. V ..■■ ■ ■..

,Tyou are still healthy

XLVIII

NORTH CAROLINA MEDICAL JOURNAL

December, 1UG0

Sterazolidin

brand of prednisone-phenylbutazone

Even in the more transient rheumatic
disorders, an anti-inflammatory effect
more potent than that provided by aspirin
is often desirable to hasten recovery
and get the patient back to work.
By combining the anti-inflammatory
action of prednisone and phenylbutazone,
Sterazolidin brings about exceptionally
rapid resolution of inflammation with relief
of symptoms and restoration of function.
Since Sterazolidin is effective in low
dosage, the possibility of significant
hypercortisonism, even in long-term
therapy, is substantially reduced.

Availability: Each Sterazolidin® capsule contains prednis
1.25 mg. ; Butazolidin®, brand of phenylbutazone, 50 mg.;
dried aluminum hydroxide gei 100 mg.; magnesium
trisllicate 150 mg.; and homatropine methylbromlde 1.25 r
Bottles of 100 capsules,

Geigy, Ardsley. New York

Geigy

165-60

Note the two tablets on the shelf above. Left, old-style sugar-coated Dayalets-M®. Right,
the same formula, but Filmtab-coated— potency's assured, but old-style bulk is cut 30%.

ON COATS:
STYLES CHANGE IN VITAMINS, TOO

Coat styles change— whether it's a blazer or a B-complex vita-
min. Not long ago, for instance, "Vitamins by Abbott" were
dressed up with a new-style coating — Filmtab®.
The most obvious result was a marked reduction in tablet size-
up to 30% in some products. The tablets themselves were bril-
liant in a variety of rainbow colors. They wouldn't chip or stick
together in the bottle. All vitamin tastes and odors— gone.

Such were the aesthetic gains. Behind these, a significant
pharmaceutical advance: with Filmtab, deterioration is slowed

a-

to an irreducible minimum, because the coating process is
essentially a water-free procedure.

Finally— most important— Filmtab guarantees that the content
of each tablet matches the formula printed on the label. While
the person taking the vitamins may not worry much about rigid
stability, Abbott does. Assures it, through Filmtab.

In short, Filmtab's a name that stands for quality, stability,
potency. The very best in vitamin coatings. Filmtab doesn't add
a penny to the cost. And it's a name found only on

ITAMINS by ABBOTT

NEWEST
NUTRITIONAL
PRODUCT
FROM ABBOTT

D meet special nutritional needs of growing teenagers

Filmtab

DAYTEENS

TRADEMARK

RICH IN IRON, CALCIUM, VITAMINS-IMPORTANT FACTORS
FOR THE GROWTH YEARS

FILMTAB-COATED TO CUT SIZE AND ASSURE FULL POTENCY

HANDSOME TABLE BOTTLES AT NO EXTRA COST (100-SIZE)

ALSO SUPPLIED IN BOTTLES OF 250 AND 1000.

W, DAYTEENS JOINS THE COMPLETE LINE
QUALITY VITAMINS BY ABBOTT:

ULETS®

e bottles ot 100

les of 50 and 250

M.ETS-M®
hecary bottles
10 and 250

i-potent maintenance
ulas— ideal for the
ritionally run-down"

OPTILETS®

OPTILETS-M®
Table bottles of
30 and 100
Bottles of 1000

Therapeutic formulas
for more severe de-
ficiencies—illness,
infection, etc.

SUR-BEX®withC
Table bottle of 60
Bottles of 100,
500 and 1000

Therapeutic formula of
the essential B-complex
plus C. for convalescence,
stress, post-surgery, etc.

EACH DAYTEENS FILMTAB® REPRESENTS

Vitamin A (5000 units) 1.5 mg

Vitamin D (1000 units) 25 meg

Thiamine Mononitrate (Bi) 2 mg

Riboflavin (B2) 2 mg

Nicotinamide 20 mg

Pyridoxine Hydrochloride 0.5 mg

Vitamin B12 (as cobalamin concentrate) 2 meg

Calcium Pantothenate 5 mg

Ascorbic Acid (C) 50 mg

Iron (as sulfate) 10 mg

Copper (as sulfate) 0.15 mg

Iodine (as calcium iodate) 0.1 mg

Manganese (as sulfate) 0.05 mg

Magnesium (as oxide) 0.15 mg

Calcium (as phosphate) 250 mg

Phosphorus (as calcium phosphate) 193 mg

VITAMINS by ABBOTT

LETS, ABBOTT

December, 1960

ADVERTISEMENTS

XLIX

WHEN

THE PATIENT

WITHOUT

ORGANIC DISEASE

COMPLAINS OF

CONSIDER

i

[ NEOCHOLAN®

Your patient will often respond promptly to Neocholan therapy. It greatly increases the flow of
thin, nonviscid bile and corrects biliary stasis by flushing the biliary system. It also relaxes intesti-
nal spasm, resulting in an unimpeded flow of bile and pancreatic juice into the small intestine.
Neocholan helps to promote proper digestion and absorption of nutrients. It also encourages
normal peristalsis by restoring intestinal tone.

PITMAN-MOORE COMPANY

DIVISION OF ALLIED LABORATORIES, INC.
INDIANAPOLIS. 'NDIANA

Each tablet provides: Dehydrocholic Acid Compound.
P-M Co. 265 mg. (Dehydrocholic Acid, 250 mg.);
Homatropine methylbromide 1.2 mg.; Phenobarbital
8.0 mg. Supplied in bottles of 100 tablets.

MM

NORTH CAROLINA MEDICAL JOURNAL

December, I960

(^)

Antirheumatic Analgesic

PLANOLAR

*

for

Rheumatoid

Arthritis

Planolar combines the cumulative
antirheumatic and anti-inflammatory
action of Plaquenil" with the prompt
analgesic action of aspirin.

Each tablet contains: Plaquenil 60 mg.

Aspirin 300 mg. (5 grains)

Plaquenil ". . . the preferred antimalarial drug for
treatment of disorders of connective tissue..."7

Aspirin belongs to ". . . the most useful group of
drugs for rheumatoid arthritis."2

%

for detailed information
(clinical experience, side
effects, precautions, etc.)

\ •>

lllliutllflOb LABORATORIES
W I New York 18, N.Y.

DOSAGE: Adults, 2 tablets two or three
times daily. After two or three months of therapy,
the patient may no longer need the added benefit
of aspirin. A maintenance regimen of Plaquenil
sulfate alone (from 200 to 400 mg. daily) may then
be substituted.

0 Planolar. trademark

REFERENCES:

1. Scherbel, A. L; Schuchter, S. L,
and Harrison, J. W.: Cleveland
Clin. Quart. 24:98, April, 1957.

2. Waine, Hans: Arthritis, rheumatoid,
in Conn, H. F.: Current Therapy 1959,
Philadelphia, W. B. Saunders Co.,
1959, p. 555.

December, 1960

ADVERTISEMENTS

LI

For Your Personal Pension Plan

The special features of the New England Life
contract will serve you to advantage

Recently we have run ads in this Journal and pointed out the new privileges to be
available to you and other professional practitioners in the formation of individual
retirement programs. We described the flexible change of plan clause in our policies,
and the special techniques and contracts developed in connection with Corporate
Pension Plans, pointing out that those features and services could well be applicable
to you personally.

The experience and services of our Company and Agency are available to you in con-
nection with your personal life insurance and retirement programs, regardless of
and independent of the Smothers, Keogh-Simpson Legislation that may be passed.
Any retirement program you may now initiate through New England Life can be
adapted through such legislation as may be passed in the future.

Again we list below our Agency Associates whose knowledge and experience may
serve you well.

AGENCY ASSOCIATES

ASHEVILLE

Henry E. Colton, C.L.U.

CHARLOTTE

A. J. Beall
Richard Cowhig
Calbert L. Dings
T. Ed Thorsen, C.L.U.

DURHAM

R. Kennon Taylor, Jr., C.L.U.

GASTON I A

Hugh F. Bryant

HICKORY

O. Reid Lmeberger

HIGH POINT

Walter M. Bullock
George P. Clark

RALEIGH

John Cates

Ryland Duke

Carlyle Morris

Reid S. Towler, C.L.U.

REIDSVILLE

James E. Everette

STATESVILLE

Tom White
WILMINGTON

Meares Harriss, ^ L.U.
Alex Urquhart, C.L.U.

WILSON

B. B. Plyler, Jr., C.L.U.
WINSTON-SALEM

Kenneth W. Maust

ARCHIE CARROLL, C.L.U., GENERAL AGENT

NEW ENGLAND

Q/y/aSm LIFE JtSSS

612 Wachovia Bank Building

Charlotte, N. C.

LII

NORTH CAROLINA MEDICAL JOURNAL

December, lltGO

WHEN ORAL PENICILLIN THERAPY
18 INDICATED

-CILLIN

K-CILLIN-500

TABLETS

Composition: Compressed tablets of Penicillin G
Potassium, buffered with Calcium Carbonate. Each
tablet contains 500,000 units of crystalline Peni-
cillin G Potassium.

Uses: In mild or moderately severe Gram-positive
infections and especially penicillin-resistant sta-
phylococcic infections. Usually well tolerated with
few if any side effects.

Dosage: One tablet every four to six hours.

Caution: Federal law prohibits dispensing without
prescription.

Supplied: Bottles of 100 and 1000.
Also Available K-CILLIN 250 — As above except
each tablet contains 250,000 units crystalline
Penicillin G Potassium.

References-. Drugs of Choice: W. Modell, M.D.,
959: Pg. 131, 132.

for SYRUP

Composition: Crystalline Penicillin G Potassium
powder, buffered with Sodium Citrate. When dis-
pensed, add 39 cc. water. Resulting red solution
will contain 500,000 units Penicillin G Potassium
in each teaspoonful (5cc). Solution will keep one
week under refrigeration. Dry powder dated.

Dosage: One teaspoonful every six hours. NOT
FOR INJECTION. Caution: Federal law prohibits
dispensing without prescription.

Supplied: 60 cc. Bottles.

References: Drugs, Their Nature, Action and Use:
H. Beckman, M.D., 1958; Pg. 502, 504, 505.

LITERATURE and CATALOG
ON REQUEST

Jwla4f/iandr

INC.

PHARMACEUTICALS

I

1042 WESTSIDE DRIVE
GREENSBORO, N. C.

December, 19G0 ADVERTISEMENTS LIII

Bin

525

Che

1119 V

SAINT ALBANS

PSYCHIATRIC HOSPITAL

(A Non-Profit Organization)

RadSord, Virginia

James P.
Daniel D. Chiles, M. D.

Clinical Director
James K. Morrow, M. D.
Silas R. Beatty, M. D.

STAFF

<ing, M. D., Director

William D. Keck, M. D.
Edward W. Gamble, III, M. D.
J. William Giesen, M. D.
Internist (Consultant)

Clinical Psychology: Don Phillips
Thomas C. Camp, Ph. D. Administrator
Artie L. Sturgeon, Ph. D.

AFFILIATED CLINICS
efield Mental Health Center Beckley Mental Health Center

) Bland St., Bluefield, W. Va. 109 E. Main Street, Beckley, W. Va.
David M. Wayne, M. D. W. E. Wilkinson, M. D.
Phone: DAvenport 5-9159 Phone: CLifford 3-8397
irleston Mental Health Center Norton Mental Health Clinic

irginia St., E., Charleston, W. Va. Norton Community Hospital, Norton, Va.
B. B. Young, M. D. Pierce D. Nelson, M. D.
Phone: Dickens 6-7691 Phone: 218, Ext. 55 and 56

TUCKER HOSPITAL, Inc.

212 West Franklin Street
Richmond, Virginia

A private hospital for diagnosis and treatment of psychiatric and neurol-
ogical patients.
Hospital and out-patient services.

(Organic diseases of the nervous system, psychoneuroses, psychosomatic
disorders, mood disturbances, social adjustment problems, involutional
reactions and selective psychotic and alcoholic problems.)

Dr. James Asa Shield Dr. George S. Fultz

Dr. Weir M. Tucker Dr. Amelia G. Wood

LIV

XORTH CAROLINA MEDICAL JOURNAL

December, 1960

[:'■■

HIGHLAND HOSPITAL, INC.

Founded In 1904

ASHEVILLE, NORTH CAROLINA

Aililiated with Duke University

A non-profit psychiatric institution, offering modern diagnostic and treatment procedures — insulin, electroshoclc, psy-
chotherapy, occupational and recreational therapy — for nervous and mental disorders.

The Hospital is located in a 75-acre park, amid the scenic beauties of the Smoky Mountain Range of Western North
Carolina, affording exceptional opportunity for physical and emotional rehabilitation.

The OUT-PATIENT CLINIC offers diagnostic service and therapeutic treatment for selected case desiring non-
resident care.

R. CHARMAN CARROLL, M.D.
Medical Director

ROBERT L. CRAIG, M.D.

Associate Medical Director

JOHN D. PATTON, M.D.
Clinical Director

r

WE PROUDLY DRAW YOUR ATTENTION

This is Diapulse®. You may be seeing it here for
the first time, for it has just begun to flow off the
production lines at Remington-Rand.

It emits pulsed short waves. Not ordinary short
waves, whose power is limited by the danger of over-
heating— but very strong short waves with intervals
of rest betwpon to allow for dissipation of heat.

We are proud to offer this fine piece
Write or ask our sale:

Experience in laboratory' and clinic indicates that
this modality is unique in its ability to stimulate
cellular activity. Any number of medical men — many
of them world-renowned — believe that treatment by
Diapulse has the capacity for aiding the patient by
causing his defense mechanism to respond with
greater zeal and efficiency.

of equipment to our many customers.

man for demonstration.

CAROLINA SURGICAL SUPPLY COMPANY

706 Tucker St.

"The House of Friendly and Dependable Service"

Tel: TEmple 3-8631

Raleigh, North Carolina

December, 1960

ADVERTISEMENTS

LV

in its completeness

ggmgHj

Digitalis

{ D«vie.v Rose t

0.1 Gram

(1W11 1V4 grains)
CAUTION: FettersI
law prohibits dispens-
inir a-rthotrt prescrip-
tion.

nim, 80st t cb.. ut

BsstM. '4av: U S •

Each pill is

equivalent to

one USP Digitalis Unit

Physiologically Standardized

therefore always

dependable.

Clinical samples sent to
physicians upon request.

Davies, Rose & Co., Ltd.
Boston, 18, Mass.

Posture is a plus

YOU CAN GET FROM SLEEPING...
THAT'S WHY IT'S WISE TO SLEEP ON A

Sealy

POSTUREPEDIC

Uniformly firm,
Sealy Posturepedic
keeps the spine
level. Healthfully
comfortable, it per-
mits proper relaxa-
tion of museulatory
system and limbs.
Exclusive "live-ac-
tion" coils support
curved, fleshy con-
tours of the body,
assuring relaxing
rest that you know
is basic to good
health . . . and good
posture.

PROFESSIONAL
DISCOUNT

$39

00

Limit of one full or

two twin size sets

Please check preference

So that you as a physician can
judge the distinctive features of the
Sealy Posturepedic mattress for
yourself before you recommend it
to your patients, Sealy offers a spe-
cial Doctor's Discount on this mat-
tress and foundation, when pur-
chased for your personal use.

SEALY MATTRESS COMPANY

666 Lake Shore Drive, Chicago 11 , Illinois

RETAIL PROFESSIONAL

Posturepedic Mattress each $79.50 OIjd stole) $60.00

Posturepedic Foundation each $79.50 '°x I $60.00

1 Full size ( ) 1 Twin size ( ) 2 Twin size ( )
Enclosed is my check and letterhead.

Please send my Sealy Posturepedic Set(s) fo:

NAME_

ADDRESS.
-ITY

LVI

NORTH CAROLINA MEDICAL JOURNAL

December, 1HG0

Decf

THIS

Doctor

IS ,he SYMBOL 0F ASSURANCE OF ETHICAL
public relations minded handling of your accounts
receivable and collection problems.

IS tne EMBLEM of sound experience in SERVICE
to the professional offices.

IS tne MARK of ° complete PROFESSIONAL
accounts receivable service.

Here Are the BUREAUS in Your Area Capable and Ready to Serve You

MEDICAL-DENTAL CREDIT BUREAU
514 Nissen Building
P. O. Box 3136
Winston-Salem, N. C.
Phone PArk 4-8373

MEDICAL-DENTAL CREDIT BUREAU
204 'v W. Morehcad, Library Building
P. O. Box 983
Reidsville, N. C.
Phone Dickens 9-4325

MEDICAL-DENTAL CREDIT BUREAU
310 N. Main Street
High Point, N. C.
Phone 88 3-1955

MEDICAL-DENTAL CREDIT BUREAU
A division of Carolina Business Services
Room 10 Masonic Temple Building
P. O. Box 924
Wilmington, N. C.
Phone ROger 3-5191

MEDICAL-DENTAL CREDIT BUREAU
212 West Gaston Street
Greensboro, N. C.
Phone BRoadway 3-8255

MEDICAL-DENTAL CREDIT BUREAU
220 East 5th Street
Lumberton, N. C.
Phone REdfield 9-3283

MEDICAL-DENTAL CREDIT BUREAU, INC.

225 Hawthorne Lane

Hawthorne Medical Center

Charlotte, N. C.

Phone FRanklin 7-1527

THE MEDICAL-DENTAL CREDIT BUREAU
Westgate Regional Shopping Center
Post Office Box 2868
Asheville, North Carolina
Phone ALpine 3-7378

BRAWNER'S SANITARIUM, INC,

(Established 1910)
2932 South Atlanta Road, Smyrna, Georgia

FOR THE TREATMENT OF PSYCHIATRIC ILLNESSES
AND PROBLEMS OF ADDICTION

MODERN FACILITI ES

Approved by Central Inspection Board of American Psychiatric Association
and the Joint Committee on Accreditation

Jas. N. Brawner, Jr., M.D.
Medical Director

Phone HEmlock 5-4486

December, 1960

ADVERTISEMENTS

LVII

ASHEVTLLE

APPALACHIAN HALL

ESTABLISHED — 1916

NORTH CAROLINA

-..■•"

k/'^T"^' 7:

An Institution for the diagnosis and treatment of Psychiatric? and Neurological illnesses, rest, convalescence, drug

and alcohol habituation.

Insulin Coma, Electroshock and Psychotherapy are employed. The Institution is equipped with complete laboratory

facilities including electroencephalography and X-ray.

Appalachian Hall is located in Asheville, North Carolina, a resort town, wnich justly claims an all around climate

for health and comfort. There are ample facilities for classification of patients, rooms single or en suite.

Wm. Ray Griffin, Jr., M.D. Mark A. Griffin, Sr., M.D.

Rorert A. Griffin, M.D. Mark A. Griffin, Jr., M.D.

For rates and further information write APPALACHIAN HALL, ASHEVILLE, N. C.

Compliments of

WachtePs, Inc*

SURGICAL
SUPPLIES

15 Victoria Road

ASHEVILLE, North Carolina

P.O. Box 1716 Telephone AL 3-7616

Protection Against Loss of Income
from Accident & Sickness as Well as
Hospital Expense Benefits for You and
All Your Eligible Dependents

All

PREMIUMS

CONE Ft OM

PHYSICIANS
SURGEONS
DENTISTS

All

BENEFITS

60 TO

PHYSICIANS CASUALTY & HEALTH
ASSOCIATIONS

OMAHA 31, NEBRASKA
Since 1902

Iandsome Professional Appointment Book sent to
you FREE upon request.

LVIII

NORTH CAROLINA MEDICAL JOURNAL

December, 19(30

Westbrook Sanatorium

Rl CHMON D

iSstublis/iod iqil

VIRGINIA

private psychiatric hospital em-
ploying modern diagnostic and treat-
ment procedures — electro shock, in-
sulin, psychotherapy, occupational
and recreational therapy — for nervous
and mental disorders and problems of
addiction.

Staff PAUL V- ANDERSON. M.D., President

RE\ BL AN KINSHIP, M.D., Medical Director

JOHN R. SAUNDERS. M.D., Assistant
Medical Director

THOMAS F. COATES. M.D.. Associate

JAMES K. HALL, JR.. M.D.. Associate

CHARLES A. PEACHEE. JR., M.S., Clinical
Psychologist

R. H. CRVTZER. Irlminislrator

Brochure nf Literature and Mews Sent On Request - P. O. Box 1514 - Phone 5-3245

a good buy in
public relations

. . . place

today's health

in your reception room

Give your order to a member of your local Medical
Auxiliary or mail it to the Chicago office.

TODAY'S HEALTH

PUBLISHED MONTHLY BY THE
AMERICAN MEDICAL ASSOCIATION
535 NORTH DEARBORN • CHICAGO 10

Please enter □, or renew □. my subscription for the
period checked below :

STREET-
CITY

CREDIT WOMAN'S AUXILIARY OF
□ 4 YEARS . . . ^06 $4. OO

□ 3 YEARS .

5/^

$3.25

COUNTY

C 2 YEARS . . .V«J*6 S2.50
□ I YEAR .... SMO * 1 .SO

! December, 1960

ADVERTISEMENTS

LIX

INDEX TO ADVERTISERS

Abbott Laboratories Insert

American Casualty Insurance Company ....XXXVIII

American Medical Education Foundation XVIII

Ames Company XXXV

Appalachian Hall LVII

Brawner's Sanitarium LVI

Brayten Pharmaceutical Company IX

Bristol Laboratories. Insert, V. XXI, XXV, XXXVII
Burroughs-Wellcome & Company XLII

Carolina Surgical Supply Co LIV

Columbus Pharmacal Company XLVI

J. L. Crumpton XXXII

Davies, Rose & Co LV

Drug- Specialties, Inc XLV

Florida Citrus Commission XX

Geig-y Pharmaceutical LXVIII

Charles C. Haskell and Company XVII

Highland Hospital LIV

Hospital Saving Assn. of N. C XXIX

Jones and Vaughan, Inc Ill

Lederle Laboratories XXX, XXXI, XXXIX

Eli Lilly & Company XXVIII, Front Cover

Mavrand, Inc LII

Medical-Dental Credit Bureau LVI

Merck, Sharp & Dohme Second Cover

Mutual of Omaha XLIII

New England Mutual Life Insurance Co LI

Parke, Davis & Co XVI, XXIV, LX, Third Cover

Physicians Casualty Association

Physicians Health Association LVII

Physicians Products Company IV

Pinebluff Sanitarium I

Pitman-Moore Company XLIX

P. Lorillard Company (Kent Cigarettes) XXXIV

A. H. Robin Company XIX, XL

Saint Albans Sanatorium LIII

Sandoz Pharmaceuticals, Inc X

Sardeau, Inc XLIV

W. B. Saunders XI

Sealy of the Carolinas, Inc LV

G. D. Searle & Co XXXIII

Smith-Kline & French Laboratories -4th Cover

E. R. Squibbs and Sons XLI

St. Paul Fire and Marine Insurance LIX

Tucker Hospital LIII

The Upjohn Company VI, VII

United Insurance Company of America XLVII

U. S. Vitamin Company Reading

Wachtel's Incorporated LVII

Wallace Laboratories XII, Insert, XIII,

XXVI, XXVII
Wesson Oil and Snowdrift

Sales Company XIV, XV

Westbrook Sanitorium LVIII

Winchester Surgical Supply Co.

Winchester-Ritch Co I

Winthrop Laboratories XXII, XXIII, XXXVI, L

RY

CHOSEN BY MEDICAL
SOCIETY OF THE STATE OF
NORTH CAROLINA FOR
PROFESSIONAL
LIABILITY INSURANCE

Head Office
412 Addison Building
Charlotte, North Carolina
EDison 2-1633

for your complete insurance needs . . .

| ^PROFESSIONAL
* PERSONAL
% PROPERTY

THERE IS A SAINT PAUL AGENT IN YOUR
COMMUNITY AS CLOSE AS YOUR PHONE

HOME OFFICE: 385 WASHINGTON ST., ST. PAUL, MINN.

SERVICE OFFICE: RALEIGH, NORTH CAROLINA — 323 W. MORGAN ST. TEmple 4-7458

for every phase of cough...
comprehensive relief

MBENYL EXPECTORANT

vibenyl expectorant quickly comforts the
Dughing patient because it is formulated to
;lieve all phases of cough due to upper
:spiratory infections or allergies. Combining
mbodryl5— potent antihistamine; Benadryl"—
ie time-tested antihistaminic-antispasmodic;
hd three well-recognized antitussive agents,

VIBENYL EXPECTORANT:

(soothes irritation • quiets the cough reflex
fidecongests nasal mucosa • facilitates expec-
tation • decreases bronchial spasm • and
istes good, too.

Each fluidounceof ambenyl expectorant • concains:
Ambodryl' hydrochloride 24 mg.

(bromodiphenhydramine hydrochloride, Parke-Davis)
Benadryl" hydrochloride 56 mg.

(diphenhydramine hydrochloride, Parke-Davis)

Dihydrocodeinone bitartrate Vfe gr.

Ammonium chloride . . 8 gr.

Potassium guaiacolsulfonate 8 gr.

Menthol q.s.

Alcohol 5%

Supplied: Bottles of 16 ounces and 1 gallon.

Dosage: Every three or four hours— adults, 1 to 2 tea-
spoonfuls; children Vz to 1 teaspoonful. :nM

• Exempt narcotic

PARKE, DAVIS & COMPANY
Detroit 32, Michigan

PARKE -DAVIS

in overweight

To improve your patients' mood and
to help them stick to their diets:

DEXAMYL

brand of dextro amphetamine and amobarbital

SoanSulG® CclDSuleS ^acn 'Dexamyl' Spansule sustained
release capsule (No. 2) contains

I 3.DIGIS • L. 1 1 X 1 T 'Dexedrine' (brand of dextro ampheta-

mine sulfate), 15 mg., and amobarbital,
1 Vi gr. Each 'Dexamyl* Spansule capsule
(No. 1) contains 'Dexedrine', 10 mg., and
amobarbital, 1 gr.

To curb appetite and to restore energy when your

patient is listless and lethargic:

DEXEDRINE® Spansule1' capsules -Tablets • Elixir

brand of dextro amphetamine

Each 'Dexedrine' Spansule sustained
release capsule contains dextro amphet-
amine sulfate, 5 mg., 10 mg., or 15 mg.

SMITH
KLINES?
FRENCH

December, 1960

575

INDEX TO VOLUME 21

January Pages 1- 44

February Pages 45- 88

March Pages 89-128

April Pages 129-172

May Pages 173-216

June Pages 217-260

July Pages 261-312

August Pages 313-356

September Pages 357-440

October Pages 441-484

November Pages 485-528

December Pages 529-580

C — Correspondence
C&O — Committees and Organizations
CPC — Clinicopathologic Conference
PM — President's Message

Abernathy E. A., 342

Abernathy, J. R., 89

Abse, D. W., 661-C

Arena, J. M., 470, 511, 553

Back, K. W., 96

Baylin, G. J., 16

Bean, J. W., 365

Bender, J. R., 220

Blanchard, G. C. 173

Blasingame, F. J. L., 31, 281

Blaylock, K., 109

Blythe W. B., 486

Bogdonoff, M. D., 19, 454

Boyette, D. P., 544

Cadmus, R. R., 233

Caldwell, E. R., Jr., 342

Callaway, J. L., 109

Calvy, G. L., 275

Carver, G. M.. Jr., 313

Cayer, D., 3S0

Chanlett, E. T., 357

Chesson, A. S„ Jr., 538

Coker, R. E., Jr., 96

Corkey, E. C, 465

Culver, V. M., 279

Davidson, A., 551

Davison, W. C, 67

Deaton, W. R., 55

DeCamp, L., 53

DeMaria, W. J. A., 495

Donnelly, J. F., 89
' Donnelly, T., 96
, Dunnagan, W. A., 45
, Dunning, E. J., 322

Ely, T. S., 367
i Ervin, S. J., Jr., 335
' Evans, E. G., Jr., 59
I Eyster, M. E., 186
' Fetter, B. F., 23

Foushee, J. H. S., 544
[ Freedman, A., 55

Gamble. J. R.. Jr., 292-C

CONTRIBUTORS

Garvey, F. K., 183

Garvin, O. D., 282

Gasque, M. R., 361

Gaul, J. S., Jr., 139

Gilbert, C. F., 270

Gilmour, M. T.. 73-CPC

Gislerud, G.. 109

Grant, I. C, 446

Green, H. D„ 661-C

Gunn, C. G., Jr., 371

Hall, J. K., Jr., 205-C

Hobbs, G. W-, III, 129

HotTmeyer, B. E„ 27

Hollandsworth, L. C, 11

Howell, C. M.. 194

Huntley, R. R., 50

Hutto, E.. 109

Ira, G. H.. Jr., 19

Irvin, J. L., 560-C

Johnson. A. N., 261, 388, 475. 516, 558

Jones, L. O., 142

Keeler, M. H., 228, 450

Kernodle, J. R., 195

Koomen, J-, Jr., 540

Kratter, F. E., 54S

Lansing, C, 441

Larson, L. W., 267

Leonard, W. A., Jr., 339

Marascalco, J., 109

Matthews, H. A., 65

McAllister, H. C, 382

McDonald, L. B„ 59

Mcintosh, H. D.. 560-C

Menefee, E. E„ 106

Meredith, J. H., 179

Miller, E. C, 244-CPC

Miller, N., 96

Mohr, J. E., 236

Montgomery, W. S.,

Murray, H. L., 183

Newton, G., 109

Orr, L. M., 264

u::i

Patrick, R. L., 23
Patterson, F. M. S., 1
Peele, J. C, 459
Persons, E. L., 148
Peschel, E„ 485, 494
Pitts, W. R., 173
Plumb, C. S., 361
Polner, W., 330
Poole. R. F., 226
Porter, R. A., 59
Portwood, R. M., 106
Prange, A, J., 546
Preston, E. J., 446
Prichard, R. W., 73-CPC:
Queen, H. O., 469
Racklev, C. R., 454
Rankin, W. S., 67
Reece, J. C, 155-PM. 217
Rees, T. T., 173, 529
Richardson, F. H., 102
Richardson, W. P., 377
Robicsek, F., 173, 529
Ross, R. A., 329
Rowe. Mrs. O., 199
Ruddock, A. E., 157-C
Russell, P. E., 223
Sanger, P. W., 173, 529
Shaffner, L., 318
Stands, H. C, 450
Shaw, D. M., 19
Shingleton, W. W., 326
Shuford, J. H., 206-C&O
Sohmer, M. F., 380
Stelling, F. H., 135
Stephen, C. R., 8
Stevenson, W. J., 540
Taylor, F. H., 173. 529
Verner, J. V., 106
Weaver. R. G., 145
Wells, H. B.. 89
Willev, E. N., 23
Zacha. E. A., 540

244-CPC

576

December, 1960

ORIGINAL CONTRIBUTORS

Abdomen, Surgical Conditions of, Acute, Symposium on

Abdominal Pain, Acute, Associated with Vascular Emergen-
cies (Carver) 313

Diagnosis and Treatment of (Shingle-

Acute,

Diagnosis and Treatment of
Acute Surgical Conditions Associated

A Case Report

Remarks

the
A Current Ap-

Cholecvstitis, Acute,
ton) 326

Diverticular Disease.
(Dunning) 322

Endometriosis, Pelvic,
with ( Ross I 329

Intussusception in Infants and Children (Shaffnerl 31S
ACTH and Corli-one Therapy, The Psychologic Effects of

(Eyster) 186
Adrenal Cortical Carcinoma, Non-hormonal:

( Freedman and Deaton ) 55
Aging

Governor's Conference on, North Carolina.
(Hodges) 501

Aged. Medical and Hospital Costs of the:
praisal (Polner) 330

Aged Person. The Health and Adjustment of the (Busse) 504

Life for the Added Years (Rowe) 199

Our Personal Challenge: The Key to Tomorrow (Kernodle)
195

Senior Citizens, Brighter Financial Prospects for ( Hobbs ) 129
Airway. Problems in the Maintenance of the (Hollands worth) 11
American Medicine. The Crisis Facing (Reece) 1
Amebiasis, Hepatic. Treated with Plaquenil:

(Queen) 469
Anemia. Sickle Cell. Roentgenologic Changes

Osteomyelitis Occurring in Children with

(Dunnagan) 45
Anesthesia— See also Medication. Preoperative

Airway. Problems in the Maintenance of the ( Hollandsworth)

Antibiotic Treatment on Roentgenologic Aspects
Disease. Influence of (Baylin) 16

Artery. Carotid. Internal. Occlusive Disease of the.

gical Treatment of Cerebral Ischemia Caused by Extra-
cranial Vascular Disease: With Special Reference to (Tay-
lor. Blanchard. Pitts. Rees. Robiscek. and Sanger) 1, .

Avulsion Wounds of the Extremities. Treatment of Gaul) 139

Bad Politics and Good Medicine Don't Mix (Orr) 264

Benzydroflumethiazide (Naturetin) A Controlled Clinical Stu<l>
Using the New Oral Diuretic. (Ira. Shaw, and Bogdonotf) 1

Berylliosis. Bones, and Behavior: An Illustrative
(Rackley and Bogdonoff) 454

Biennial Registration, The (Coombs) 346-C&0

Biennial Registration Act, The (Gamble) 292-C

Bitter Apple (Citrullus Colocynthisl Poisoning:

of Its Use as an Abortifacient (Patrick. Willey. and Fetter)
23

Blue Shield Consultants (Shuford)

Brain — See Cerebral

Breast Feeding: Going or Coming?

Carcinoma

Adrenal Cortical, Non-hormonal:

and Deaton) 55
Of the Lung, Abnormal Water _.

Report of a Case with Hyponatremia (Portwood. Verner,
and Menefee) 106

Cardiac Fibroma of the Interventricular Septum in
Infant ( Boyette and Foushee) 544

Cerebral Ischemia. The Surgical Treatment of Caused by Ex-
tracranial Vascular Disease: With Special Reference of Oc-
clusive Disease of the Internal Carotid Artery (Taylor.
Blanchard. Pitts. Rees, Robicsek, and Sanger) 173

Carotid Artery— See Artery. Carotid

Challenge. Our Personal: The Key to Tomorrow (Kernodle) 195

Child. Deaf. The Doctor and the (Hoffmeyer) 2.

Childhood Nephrosis. Management of (DeMaria) 49f>

Children — See also Infants and Children

Gifted. Problems of Adjustment of (Lansing) 441
Trimeprazine (Temaril) as an Antimetic and Antitussive in

Cholecystitis, "Acute, Diagnosis and Treatment of (Shingleton)

Chronic Disease Program in the Charlotte-Mecklenburg
Countv Health Department (Corkey) 465
Chronic D'isease — See Disease. Chronic
(Citrullus Colocynthisl Bitter Apple. Poisoning: A Discussion

of Its Use as an Abortifacient (Patrick, Willey. and Fetter)

Colon. Acute Diverticular Disease of the: The Diagnosis and

Treatment of (Dunning) 322
Coma Hepatic. Selected Cases of. Chronic Renal Failure. In-
tractable Edema. Additional Uses of the Artificial Kidney:

(Kelemen) 492
Compulsory Insurance (Hall) 205-C
Congress. Medical Problems Facing (Ervin) 33o
Cornell Medical Index Health Questionnaire as

Aid (Huntley) 50
Costs. Medical and Hospital, of the Aged: A

praisal (Polner) 330
Deaf Child. The Doctor and the (Hoffmeyer) 27 . .

Deliveries. Distribution of. Among North Carolina Physicians

in 1958. with Some Implications for the Future, (Donnelly,

Wells and Abernathy) 90
Depression. Current Trends in the Use of Monoamine Oxidase

Inhibitors in (Prange) 546
Dermatology — See Methdilazine Hydrochloride

Case Report

in Salmonella
and without

of Mastoid
The Sur-

Case Report.

A Discussion
,'illei

And Why? (Richardson) 102

A Case Report ( Freedman

Retention Associated with:
1. V

Newborn

a Diagnostic
Current Ap-

Dialysis. Panel Discussion on

Opening Remarks ( Peschel > -Is,",

Artificial Kidnev in the Treatment of Acute Tubular Necro-
sis (Blythe) 486
Artificial Kidney in Poisonings. The Use of (Felts) 490
Artificial Kidney. Additional Uses of: Chronic Renal Failure.
Intractable Edema, Hepatic Coma. Selected Cases of
(Kelemen) 492
Diarrhea. Acute. Salmonella and Shigella Infections Found in

195 Cases of (Caldwell and Abernathy l 342
Disease

Chronic, Program in the Charlotte-Mecklenburg County

Health Department (Corkey) 465
Diverticular, of the Colon (Dunning) 322
Mastoid. Influence of Antibiotic Treatment on Roentgenologic

Aspects of (Baylin) 16
Silo-Filler's: Report of Two Cases (Evans. McDonald, and

Porter) 59
Vascular, Extracranial, The Surgical Treatment of Cerebral
Ischemia Caused by, with Special Reference to Occlusive
Disease of the Internal Carotid Artery (Taylor, Blanchard.
Pitts. Rees, Robicsek. and Sanger) 173
Virus. Generalized Salivary Gland, in Postneonatal Life (Gil-
bert ) 270
Diuretic. Oral, Benzydroflumethiazide (Naturetin): A Con-
trolled Clinical Study Using the New (Ira, Shaw, and Bog-
donoff) 19
Diverticular Disease of the Colon. Acute. Diagnosis and Treat-
ment of (Dunning) 322
Dressier. The Post-Myocardia! Infarction Syndrome of: Case

Report (Jones) 142
Edema. Intractable, Selected Cases of. Chronic Renal Failure,
Hepatic Coma. Additional Uses of the Artificial Kidney
(Kelemen) 492
Electrical Injuries — See Injuries, Electrical
Esophageal Emergencies (Taylor, Sanger, Robicsek. and Rees.)

529
Drug Promotion. Ethical. Statement of Principles (Pharma-
ceutical Manufacturers Association) 151
Emphysema, Pulmonary, Treatment of (Russell) 223
Endometriosis. Pelvic. Acute Surgical Conditions Associated

with (Ross) 329
Federal Employees Health Benefits Program (Ruddock) 157-C
Fibroma. Cardiac, of the Interventricular Septum in a New-
born Infant (Boyette and Foushee) 544
Fungus Infections — See Infections. Fungus
General Practice, The Medical Student, Specialization, and

( Coker. Miller. Back, and Donnelly) 96
Gland, Salivary. Virus Disease, Generalized, in Postneonatal

Life (Gilbert) 270
Glaucoma

Detection Center, Experiences in a (Tillett) 509
Early. Simple, An Approach to the Problem of (Weaver) 14.",
Medical Treatment of (Davidson) 551
Government Benefits (Committee on Veterans Affairs) 156-C&0
Granulomatosis. Wegener's (Miller and Prichard) 244-CPC
Griseofulvin. Oral, The Treatment of Superficial Fungus In-
fections of the Skin with (Callaway, Newton, Gislerud. Hutto,
Marascalco. and Blaylock) 109
Hamilton, Dr. John Homer (North Carolina State Board of

Health) 249-C&0
Health — See also Public Health

Health and Adjustment of the Aged Person (Busse) 594
Health Benefits Program. Federal Employees (Ruddock) 157-C
Heart

The Postmvocardial Infarction Syndrome of Dressier: Case
Report (Jones) 142
Hepatic Amebiasis Treated with Plaquenil: A Case Report

(Queen) 269
Hepatic Coma. Chronic Renal Failure. Intractable Edema, Se-
lected Cases of. Additional Uses of the Artificial Kidney
(Kelemen) 492 , ,

Hospital. Clinical Practice in the. Analysis. Review and Eval-
uation of (Babcock) 511
Hospital. General. The Tissue Committee in a (DeCamp) 53
Hvdrated Magnesium Aluminate. Antacid Properties of. Clin-
ical Evaluation of (Cayer and Sohmer) 380
Hyponatremia. Abnormal Water Retention Associated with
Carcinoma of the Lung: Report of a Case with (Portwood.
Verner. and Menefee) 106
Idiopathic Myocarditis — See Myocarditis. Idiopathic
Industrial Medical Program. Economic Influences of. on a

County Society (Gasque and Plumb) 361
Industry. Radiation Hazards in (Ely) 367

Infants . ...

Infant. Newborn. Cardiac Fibroma of the Interventricular

Septum in a: A Case Report I Boyette and Foushee) 144
Premature, A Follow-up Study of. Born in Wake County.
1948-1951: A Preliminary Report (Grant and Preston) 446
and Children. Intussusception in (Shaffner) 318
Infarction. The Post-Myocardial. Syndrome of Dressier: A Case
Report (Jones) 142

Infections m _ ...

Fungus. Superficial, of the Skin. The Treatment of. with
Oral Griseofulvin (Callaway. Newton, Gislerud. Hutto.
Marascalco, and Blaylock) 109
Salmonella and Shigella. Found in 195 Cases of Acute Diar-
rhea (Caldwell and Abernathy) 342

Staphylococcic. Pulmonary, Antibiotic Resistant, (Calvy) 275

December, 1960

577

Urinary Tract, Resistant, A Clinical and Laboratory Study
of Combined Mandelamine and Thiosulfil in (Garvey and
Murray) 183

Injuries — See also Wounds

Electrical, Resuscitation in (Meredith) 179
Wringer (Stelling) 135

Insurance, Compulsory (Hall) 205-C

Insurance, Health, and the Practice of Medicine (Mohr) 236

Internist and Other Non-surgical Specialists, the Position of
the, in the Pattern of Medical Care (Persons) 148

Intussusception in Infants anTl Children ( Shalfner ) 318

Ischemia, Cerebral, Caused by Extracranial Vascular Disease,
with Special Reference to Occlusive Disease of the Internal
Carotid Artery (Taylor, Blanchard, Pitts, Rees, Robicsek,
and Sanger) 173

Larynx, The, in Health and Disease: A Photographic Study
(Peele) 459

Leptospirosis: Report of a Case (Leonard) 339

Liver

See Hepatic Amebiasis
See Hepatic Coma

Lung — See also Pulmonary

Lung, Carcinoma of the. Abnormal Water Retention Associate.!
with: Report of a Case with Hyponatremia ( PortwooJ,
Verner, and Menefee) 106

Mail Order Prescription Services (McAllister) 3S2

Mandelamine and Thiosulfil, Combined, in Resistant Uri^iry
Tract Infections, A Clinical and Laboratory Stuiy of ( Gar-
vey and Murray) 183

Manufacturing, Textile, Physical Requirements in ( Gunn) 371

Mastoid Disease, Influence of Antibiotic Treatment on Roent-
genologic Aspects of (Baylin) 16

Medical and Hospital Costs of the Aging: A Current Appraisal
(Polner) 330

Medical Care (Johnson) 3SS-PM

Medical Care, The Position of the Internist and Other Non-
surgical Specialists in the Pattern of (Persons) 148

Medical Index, Health Questionnaire, Cornell, as a Diagnostic
Aid (Huntley) 50

Medical Issue in Politics, The ( Johnson ) 475-PM

Medical Problems Facing Congress (Ervin) 335

Medical Research ( Irvin, Mcintosh, Green) 559-C

Medical Student, The, Specialization, and General Practice
Coker, Miller, Back, and Donnelly) 96

Medication, Preoperative, Changing Concepts in (Stephen) S

Medicine

American, The Crisis Facing (Reece) 155-PM

Good Medicine, Bad Politics and, Don't Mix (Orr) 264

Practice of. Health Insurance and the (Mohr) 236

Mental Deeficiency, The Ocular Manifestations of Congenital
Toxoplasmosis in 5 out of 586 Cases of. Examined in a State
Institution for Mentally Retarded Children (Kratter) 548

Methdilazine Hydrochloride as an Antipruritic Agent, Evalua-
tion of (Howell) 194

Mid-Year Report (Johnson) 55S-PM

Monoamine Oxidase Inhibitors in Depression, Current Trends
in ( Prange) 546

Myocarditis, Idiopathic (Gilmour and Prichard) 73-CPC

Necrosis, Tubular, Acute, The Use of the Artificial Kidney in
the Treatment of (Blythe) 486

Nephrosis, Childhood, The Management of (DeMaria) 495

North Carolina

Nursing in, Some Facts About (Culver) 279
Physicians, Distribution of Deliveries Among, with Some
Implications for the Future (Donnelly, Wells, and Aber-
nathy) 89
Prison System, The Problem of Psychosis Among Felons in
(Keeler and Shands) 450

North Carolina's Occupational Health Needs, Meeting, Through
Our State Agencies (Chanlett) 357

Nursing in North Carolina, Some Facts About (Culver) 279

Obstetrics — See Deliveries

Occupational Health, Symposium on

Compensable Occupational Disease under the North Carolina

Workmen's Compensation Act ( Bean ) 365
Economic Influences of an Industrial Medical Program on a

County Society (Gasque and Plumb) 361
Meeting North Carolina's Occupational Health Needs Through

Our State Agencies (Chanlett) 357
Physical Requirements in Textile Manufacturing (Gunn) 371
Radiation Hazards in Industry (Ely) 367

Occupational Health: The Governor's Council on: A Medium
of Cooperative Effort for the Health of the Worker (Rich-
ardson) 377

Ocular Manifestations of Congenital Toxoplasmosis in 5 out
of 586 Cases Examined in an Institution for Mentally Re-
tarded Children (Kratter) 548

Osteomyelitis, Salmonella, Occurring in Children with and
without Sickle Cell Anemia ( Dunn a can ) 45

Our Personal Challenge: The Key to Tomorrow (Kernodle) 195

Pancreatitis, Chronic, The Choice of Surgical Procedures in
the Treatment of (Patterson) 1

Patient Care, Progressive (Cadmus) 233

Pediatrics

Breast Feeding: Going or Coming? And Why? (Richardson)

102
Generalized Salivary Gland Virus Disease in Postneonatal
Life (Gilbert) 270
Physician, The Role of a, in a Changing Society (Matthews) 65

Poisoning

Chlorinated Insecticides (Arena) 470

( Citrullus Colocynthis ) Bitter Apple : A Discussion of Its
Use as an Abortifacient (Patrick, Willey, and Fetter) 23

Kerosene, Gasoline, and Petroleum Distillates (Arena) 511
Use of the Artificial Kidney in (Felts) 490

Politics, Bad, and Good Medicine, Don't Mix (Orr) 264

Politics, Medical Issue in ( Johnson ) 455-PM

Practice, General, The Medical Student, Specialization, and
(Coker. Miller, Back, and Donnelly) 96

Premature Infants Born in Wake County, 1948-1951, A P'ollow-
up Study of (Grant and Preston) 446

Prescription Services, Mail Order (McAllister) 382

President's Farewell Address (Reece) 217

President's Inaugural Address (Johnson) 261

Private Physician, Public Health Assists the (Bender) 220

Progressive Patient Care (Cadmus) 233

Psychiatry

Psychosis Among Felons in the North Carolina Prison Sys-
tem. The Problem of (Keeler and Shands) 450
Short-term Group Therapy with Hospitalized Non-psychotic
Patients (Keeler) 228

Psychologic Effects of ACTH and Cortisone Therapy (Eyster)
186

Public Health — See also Health, Public

Public Ke^ith Assists tiie Private Physician ( Bender) 220

Pulmonary ^r.physema. Treatment of (Russell) 223

Pulmonary htapn/iococcic Infections, Antiuiotic Resistant (Cal-
vy) 275

R^.ation Hazards in Industry (E!v) 367

Rar.kin, Dr. Watson S., M.D. (Davison) 67

iv23uscJtation in E ectrical Injuries ( Mere.lith) 179

Retention, Water, Abnormal, Associate 1 with Carcinoma of the
Lung ( Portwood, Verner, and Menefee) 106

Roe.-.tgeno'ogic Aspects of Mastoid Disease, Influence of Anti-
biotic Treatment on (Baylin) 16

Roentgenologic Changes in Salmonella Osteomyelitis Occurring
in Children with and without Sickle Cell Anemia ( Dunna-
gan) 45
Rural Home Care Program. A (Garvin) 282

Salivary Gland — See Gland, Salivary

Salmonella and Shigella Infections Found in 195 Cases of Acute
Diarrhea ( Caldwell and Abemathy ) 342

Salmonella Osteomyelitis, Roentgenologic Changes in. Occur-
ring in Children with and without Sickle Cell Anemia (Dun-
agan) 45

Senior Citizens, Brighter Financial Prospects for Our (Hobbs)
129

Si!o-Filler's Disease: Report of Two Cases in Henderson
County, North Carolina (Evans, McDonald, and Porter) 59

Skin, Fungus Infections of the. Superficial, The Treatment of,
with Oral Griseofulvin (Callaway, Newton, Gislerud, Hutto,
Marascalco, and Blaylock ) 109

Specialization, The Medical Student, and General Practice
(Coker, Miller, Back, and Donnelly) 96

Specialists, Non-surgical, The Position of the Internist and, in
the Pattern of Medical Care (Persons) 148

Staphylococcic Infections — See Infections, Staphylococcic

Surgery

Abdomen. Acute Surgical Conditions of the. Symposium on.
Abdominal Pain, Acute, Associated with Vascular Emergen-
cies (Carver) 313
Cholecystitis, Acute, Diagnosis and Treatment of (Shingle-
ton) 326
Diverticular Disease of the Colon, Acute, Diagnosis and

Treatment of (Dunning) 322
Endometriosis, Pelvic, Acute Surgical Conditions Associated

with (Ross) 329
Intussusception in Infants and Children ( Shaffner) 318
Pancreatitis, Chronic, The Choice of Surgical Procedures in

the Treatment of (Patterson) 1
Cerebral Ischemia Caused by Extracranial Vascular Disease,
Surgical Treatment of: with Special Reference to Occlu-
sive Disease of the Internal Carotid Artery (Taylor, Blan-
chard, Pitts, Rees, Robiscek, and Sanger) 173

Syndrome

Anterior Tibial, The (Montgomery) 231

Post-myocardial Infarction Syndrome of Dressier (Jones) 142

Thiosulfil, Combined Mandelamine and, in Resistant Urinary
Tract Infections, A Clinical and Laboratory Study of (Gar-
vey and Murray) 183

Three Great Challenges (Larson) 267

Tissue Committee. The. in a General Hospital (DeCamp) 53

Toxoplasmosis, Congenital, The Ocular Manifestations of, in
5 out of 586 Cases Examined in a State Institution for Re-
tarded Children (Kratter) 548

Treatment, Antibiotic, Influence of, on Roentgenologic Aspects
of Mastoid Disease (Baylin) 16

Trimeprazine (Temaril) as an Antiemetic and Antitussive in
Children (Poole) 226

Urinary Tract Infections, Resistant, A Clinical and Labora-
tory Study of Combined Mandelamine and Thiosulfil in (Gar-
vey and Murray) 183

Virus Disease, Generalized Salivary Gland, in Postneonatal
Life (Gilbert) 270

Waterborne Illness, An Outbreak of Unusual, in Wayne County:
Epidemiologic Aspects (Koomen, Zacha, Stephenson, and
Chesson) 540

Waterborne Disease, An Outbreak of, in a City School
(Chesson) 538

Wegener's Granulomatosis (Miller and Prichard) 244-CPC

Workmen's Compensation Act, the North Carolina, Compen-
sable Occupational Diseases under (Bean) 365

Wounds, Avulsion, of the Extremities, Treatment of (Gaul) 139

Wringer Injuries (Stelling) 135

578

December, 1H6(

EDITORIALS

Aging, Regional Conference on, 1 13

Arc Discrimination in Employment, Abolish, 386

A.M.A.'s One Hundred Ninth Annual Meeting, 289

Ambulance, The Speeding. 887

American Association of Doctor's Nurses, 20.'.

Arthritis Hoax, The, 344

Arthritis, Immune Milk for, 202

Auxiliary Christmas Cards, 514

Blue Shield and the Longer View. 203

Blue Shield and the New Challenge, 474

Blue Shield, The Long View of. 154

Brighter Prospects for Senior Citizens. 154

Cancer. Common Sense, and Bureaucracy, 204

Controlled Study, A.. 35

Corrections, Three, 344

County Medical Society Officers' Conference, 70

Credit Bureaus, Medical, North Carolina's Committee on, 345

Cured Cancer Conference, 72

Davison, Dean W. C, Resigns As Duke Me lical School Dean. 153

Disease, Silo-Filler's, 72

Donley, Dr. John E., 515

Drugs, Naming New, 34:;

Duke Hospital, Orchids for, 3fi

Evangelist Says World End Near. 473

Executive Council Meeting, Midwinter, 1 12

Kail Meeting of the Executive Council, 513

Harper's Supplement, The. 557

Hart, Dr. Deryl, President of Duke, 202

Health and Income, 153

Health Bulletin, Dr. Preston— New Editor of, 345

Imaginary Poverty, 473

Immune Milk for Arthritis, 202

Influenza Immunization Urged, 515

Mail Order Prescriptions, 387

Masculinity and Smoking, 36

Medical Care for Older People, 556

Medical Credit Bureaus, North Carolina's Committee on, 345

Medical Minds Meet in Moscow, 242

Medical Prepayment and Our Social Philosophy, 29 1

Medical Research, Choked by Dollars, 72

Medical Research, More About, 566

Medical Security, Which Path to?# 72

Midwinter Executive Council Meeting, 1 !2

Mississippi Doctor, The, 35

Mortality Study, Plans for, in I960, 71

Moscow, Medical Minds Meet in, - 12

National Election, The, 385

1960, 34

North Carolina's Committee on Me lical Cre lit Bureaus, 345

North Carolina Medical Journal Changes Printers, The, 557

Nurses and Nursing, 291

Occupational Health Issue. 387

Old Order Changeth, The, 2*9

Older People. Medical Care for, 556

One Hundred Sixth Annual Sessk

Pills and Politics, 152

Post-Election Reflections, 555

Povertv, Imaginary, 472

Our S<

38S

of Heallh Bulletin.

Utter

forth

\ ■::.
, rtta
\ irth
S r:!.
|i '■■
\ rth
Sorth
I-

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[ ..i
:- '■-.■.'

; .-

Profc
Cto

:r.
•■■,'•■

• V

Eotitb

: .■''■

MO

phii

i»phy.

(44

Prepayment, Medical, am

Prescriptions, Mail Ordet

Preston. Dr. — New Editoi

Project Hope, 474

Psvchiatric Patients in a General Hospitn

Rankin, Dr. W. S.. 35

Regional Council on Aging, 1 13

Russia, The Three R.'s in, 153

Sabin Live-Virus Polio Vaccine Approved, 386

Senior Citizens, Brighter Prospects for. 154

Silo-Killer's Disease, 72

Smoking, Masculinity and, 36

Speeding Ambulance, The. 3S7

Spies, Dr. Tom D., 154

"Symptomatic Medicine," 290

Three Corrections, 344

Yale School of Medicine Celebrates Sesquecentennial

"You Are Old Father William." 345

M

SOCIETIES AND ORGANIZATIONS

Air Research and Development Command, 569

American Academy of Arts and Sciences, 40

American Board of Obstetrics and Gynecology, 39. 85, 162, 253,

305, 395, 567
American College of Gastroenterology, 253, 395
American College of Chest Physicians, 39, 85, 395, 479
American College of Obstetricians and Gynecologists, 122
American College of Surgeons, 39, 85, 122, 305, 479, 521, 567
American Geriatrics Society, 306
American Hearing Society, 306
Animal Care Panel, 396

The Month in Washington, 43. 85, 127, 166, 214, 257, 308, 401,

524, 572
American Medical Association, 122, 162, 210, 479

House of Delegates, One Hundred Ninth Annual Meeting, 285

Industrial Health Congress, 349

Report of Thirteenth Clinical Meeting, 31

Symposium on Clinical Nutrition, 521
American Medical Writers' Association, 39, 211, 395. 566
American Nursing Association, 568
American Red Cross, 305
American Psychiatric Association, 479
American Physicians Art Association, 161
American Society for Clinical Nutrition, 350

American Society of Psychosomatic Dentistry' and Medicine, 40
American Rhinologic Society. 350
American Urological Association, 351
Arthritis and Rheumatism Foundation, 211. 668
Association of American Medical Colleges. 211, 252, 480
Association of Military Surgeons, 568

Auxiliary to the Medical Society of the State of North Carolina
Bahamas Conferences, 482
Biological Photographic Association, 306
Bowman Gray School of Medicine of Wake Forest College. 38,

82. 120. 160. 209, 250, 303, 348, 390, 477, 519, 562
Catholic Hospital Association. 305, 396
Central Carolina Rehabilitation Hospital. 520
College of American Pathologists, Southeastern Region. 350
Coming Meetings, 37. 80, 119, 157. 206, 250, 300, 346, 389, 476,

517, 562

Conference on Neuropsychopharmacology. 568

County Societies, S3, 122, 210. 304. 349. 393, 520, 565

Duke University Medical Center, 38, 80, 120, 160, 207, 251, 301

349, 391, 517, 564
Emory University School of Medicine, 395
Federal Aviation Agency, 254
Forsyth County Cancer Symposium, 82, 565
Georgia Warm Springs Foundation, 350
Gill Memorial Eye, Nose and Throat Hospital, 520
Greensboro Academy of Medicine, 82
Guild of Prescription Opticians of America, 395
Industrial Health Congress, A.M. A., 210, 349
Institute on Science in Law Enforcement, 211
International Congress of Allerlogy. 568
International Congress on Congenital Malformations, 123
International Congress on Nutrition, 351
International Congress of Physical Medicine, 40. 163
International Medical Advisory Bureau, 210
International Medical Assembly, 40
International Poliomyelitis Conference. 124
Inter-state Postgraduate Association, 305

Joint Council to Improve the Health Care of the Aged, 164
Medical Society of the State of North Carolina

Committee and Commission Appointments, 1960-1961, 293

One Hundred Sixth Annual Session
Preliminary Program, 114
Transactions of. Supplement to the April issue

New Members, 37, 80, 119, 157, 206, 250. 347, 390. 476

Roster of Members, Supplement to the December issue
National Association of Blue Shield Plans, 85. 306
National Conference on the Medical Aspects of Sports, 395
National Foundation, 395, 521

Health Scholarships. 123
National Epilepsy League, 211
National League for Nursing, 305
National Tuberculosis Association, 351
New Hanover Medical Symposium, 83, 253
New Orleans Graduate Medical Assembly, 566
News Notes. 83, 304. 350, 393, 520

961 December, 1960

579

North Carolina Academy of General Practice, 39, 253, 349

North Carolina Heart Association, 121, 161, 393

North Carolina Hospital Association, 253

North Carolina Hospitals, Board of Control, 520

North Carolina Hospital Food Service Institute, 39

North Carolina Kidney Disease Foundation, 565

North Carolina Radiological Society, 565

North Carolina State Board of Health, 249-C&0

North Carolina State Board of Medical Examiners, 253, 393,

346-C&0
North Carolina Surgical Association, 39
Pan-Pacific Surgical Association, 124
Pediatric Research Institute. 565
Pharmaceutical Manufacturers Association. 151
Professional Group on Medical Economics, North Carolina

Chapter, 478
School Health Meeting, Pre-Convention, A.M. A.. 210
Seaboard Medical Association, 206
Seminar on Athletic Injuries, 393
Society on Nuclear Medicine, 396
Southeastern Allergy Association, 350
Southeastern Rural Health Conference, 393

Southeastern Surgical Congress, 395
Southern Medical Association, 84, 161, 350

Section on Ophthalmology and Otolaryngology, S4

Symposium on Pyelonephritis, 478
Southern Regional Education Board, 253
Student American Medical Association, 567

Symposium on Tuberculosis and Other Pulmonary Diseases, 163
Tri-State Medical Association, 83
University of North Carolina School of Medicine, 37, 81, 121,

159, 208, 251, 302, 347. 476, 518, 563
United States Air Force, 254

United States Civil Service Commission, 165, 308, 396
United States Department of Health. Education and Welfare,

41. 124, 164. 212, 254, 307, 351, 397, 481, 521, 569
Veterans Administration, 125, 165, 213. 255, 352, 398, 481, 522
Watts Hospital Symposium, 520
Winston-Salem Heart Symposium, 392
World Congress of Psychiatry, 351
World Federation of Neurology, *41

World Meiical Association, 85, 165, 257. 351, 521, 568
Yale University School of Medicine, 124

BOOK REVIEWS

Beat mont, W.: Experiments and Observations on the Gastric
Juice and the Physiology of Digestion, 483

Brock, S. (ed) : Injuries of the Brain and Spinal Cord and
Their Coverings, 169

Cam AC, C. N. B. (collector) : Classics of Medicine and Sur-
gery, 483

Castellani, A.: A Doctor in Many Lands, 354

Clark, M.: Medicine Today, 399

Clenden'ING, L. (compiled with notes by) : Source Book of
Medical History, 483

Cohn, I., and Deutsch, H. B.: Rudolph Matas: A Biography
of One of the Great Pioneers in Surgery, 355

Cole, W. H., and Puestow, C B.: First Aid: Diagnosis and
Management, 259

De Weese, D. D., and Saunders, W. H.: Textbook of Otolayn-
gology, 127

Fishbein, M. (ed.) : The Modern Family Health Guide, 42

Fischer, C. C: The Role of the Physician in Environmental
Peiiatrics 570

Gordon. B. L.: Medieval and Renaissance Medicine, (trans-
lator) 126; Moses Ben Maimon ( Maimonides) : The Preser-
vation of Youth, 400

Guttmacher, A. F. and Rovinsky, J. J. (ed.): Medical, Sur-
gical and Gynecological Complications of Pregnancy, 258

HrLHARD, M.: Women and Fatigue, 310

Illing worth, R. S.: The Development of the Infant and
Young Child, 571

Jakobovitch, I.: Jewish Medical Ethics. 42

Johnson, W. M. (ed.): The Older Patient, 167

Kevorkian, J.: The Story of Dissection, 311

Kobler. J.: The Reluctant Surgeon: A Biography of John

Hunter, Medical Genius and Great Inquirer of Johnson's

England, 168
Marvin, H. M.: Your Heart: A Handbook for Laymen, 168
Merck Index (ed. 7), 168

Modell. W. (ed.): Drugs of Choice 1960-1961, 126
New York Academy of Sciences: Biology of Pleuropneumonia-

like Organisms, 309: Radiopaque Diagnostic Agents, 310
Moore, A.: Mustard Plasters and Printer's Ink, 483
Proctor, I. M. : One Hundred Years' History of the North

Carolina Board of Medical Examiners: 1859-1959, 126
Rieser, W.: A History of Neurology, 310
Roberts, S. E.: Ear, Nose and Throat Dysfunctions Due to

Deficiencies and Imbalances, 168
Roth, A.: The Teen-Age Years: A Medical Guide for Young

People and Their Parents. 311
Scholz, R. O.: Sight: A Handbook for Laymen. 571
White. K. L., and Others. Manual for the Examination of

Patients, 399
Young, R. K., and Meiburg, A. L.: Spiritual Therapy, 215
Wolstenholme, G. E. N., and O'Connor, C. M. (ed.): Signifi-
cant Trends in Medical Research, 258: Virus Virulence and

Pathogenicity, 310; Congenital Malformations, 576; Human

Pituitary Hormones, 570

IN MEMORIAM

Barker, Christopher, Sylvanus, I
Brian, Earl W., 401, 527
Fleming, Major Ivey, 260
Green, William Wills, 312
Hinnant, Milford, 484
Houser, Oscar .Julian, 87
Jones, Ransom, D., 171
Martin, Moir S., 171
Matheson, Robert A., 356
McGowan, Joseph Francis, 525
Ramsay, James Graham, 401

Roberts, Bryan Nazer, 259
Rose, Abraham Hewitt, 484
Royster, Hubert Ashley, 169
Simpson, Henry Hardy, 171
Sloan, Henry Lee, 88
Smith, Frank C, 172
Stanley, John Haywood 572
Thorp, Adam Tredwell, 527
Todd, Lester C, 12S
Tyler, Earl Runyon. 216

580

NORTH CAROLINA MEDICAL JOURNAL

December, 1SJG0

The Month in Washington

(Continued from page 572)

medical insurance" for older persons. "It
would provide them hospital benefits, nurs-
ing- home benefits, and x-rays and laboratory
tests on an outpatient basis," he said in his
campaign for the presidency.

He said the Kerr-Mills legislation enacted
into law last summer is inadequate. The
medical profession supports this federal-
state program to provide health care for
needy and near-needy aged persons. In ap-
proving the Kerr-Mills program, Congress
rejected the Social Security approach es-
poused by Kennedy and union labor leaders.

Kennedy's medical program also included :
federal grants for construction, expansion
and modernization of medical, dental, and
public health schools; federal loans and
scholarships for medical students; federal
grants for renovating older hospitals; in-
creased federal financial support for med-
ical research, including basic research, and
expansion of federal programs for the re-
habilitation of handicapped or disabled per-
sons.

Food and Drug Administration employes
have been cleared of conflict-of-interest
charges brought up in the Senate Antitrust
and Monopoly Subcommittee's investigation
of the drug industry.

A three-member investigating group ap-
pointed bv Arthur S. Flemming, Secretary
of Health, Education and Welfare, examined
the financial records of 900 FDA employes.
The special investigators then reported:

"On the basis of all the evidence before
us, it is our judgment that there are no
present employes of the FDA whose sources
of personal income are incompatible with
their government employment."

The investigators continued to analyze "a
mass of fact and opinion" in connection with
charges that there has been too close a re-
lationship between some FDA employes and
drug companies which they check for con-
formance to goverment regulations.

The investigators anticipated that their
final report would show the possibility of
organization or procedural improvements in
the FDA.

The charges were triggered by disclosure
at the Subcommittee investigation that Dr.
Henry A. Welch, Director of the FDA's An-
tibiotics Division, had received $287,000
over eight years as a writer and editor for
antibiotics publications. After the disclos-
ure, Flemming ousted Welch from the gov-
ernment post.

The Federal Children's Bureau reported
that the infant death rate in the United
States has declined since 1958 but still shows
the effect of a 1957-'58 setback.

There was a steady decline in U. S. infant
deaths during the 1950's but increases in
1957 and 1958. Since then, the infant death
rate has headed downward again but still
hasn't made up the lost ground, even though
the provisional rates for 1959 (26.4 deaths
under one year per 1,000 live births) and
the first half of 1960 (25.9 per 1.000)
showed improvements.

In 1915, when data were first gathered on
infant mortality in this country, the rate
was 99.9 per 1,000. By 1940, this had been
cut to 47 and by 1950, it had been reduced to
29.2.

An all-time low of 26 was registered in
1956. It edged up to 26.3 in 1957 and 27.1
in 1958.

According to the 1959 United Nations
Demographic Yearbook, nine other countries
reported lower infant mortality rates than
the United States in 1958. They were: Swe-
den 15.8, Netherlands 17.2, Australia 20.5,
Norway 20.5, Switzerland 22.2, United
Kingdom 23.3, Denmark 23.4, New Zealand
23.4 and Finland 24.5.

Russia reported a rate of 81 in 1950 and
40.6 in 1957, latest year for which data were
reported.

Persons with heart and blood vessel dis-
eases have been urged to consult their phy-
sicians about routine vaccination against
influenza.

In a joint statement, the American Heart
Association and the National Heart Insti-
tute of the U. S. Public Health Service said
that "evidence of the past three years abun-
dantly confirmed that dangers of influenza
are much greater for patients with heart or
lung disease than for others." The risk was
described as "particularly high for those
with lung congestion due to heart disease."

'-,